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UNITED STATES OF AMERICA 



* ME 




* * * 



FOUNDED 1836 



WASHINGTON, D. C. 



GPO 16—67244-1 



AND 



OBSERVATIONS. 



BY BENJAMIN RUSH, M. D. 

1-norEsson OF THE institutes and practice of medicine and of clinical 

rnACTICE, IN THE UNIVERSITY OF PENNYSYLVANIA. 



FOUR VOLUMES IN TWO. 



VOL. III. 



THE FOURTH EDITION. 



PHILADELPHIA: 

PRINTED FOB B. & T. KITE, No. 20, NORTH THIBD STREET. 
Griggs & Dickinsons, Printers. 

1815. 




CONTENTS OF VOLUME III. 



page 
OUTLINES of the Phenomena of Fever 1 

An Account of the Bilious Yellow Fever, as it appear- 
ed in Philadelphia in 1793 37 
An Account of the Bilious Yellow Fever, as it appear- 
ed in Philadelphia in 1794 195 
An Account of Sporadic Cases of Bilious Yellow 
Fever as they appeared in Philadelphia in 1795 and 
1796 239 



Ufl^i 



OUTLINES 



OF THE 



PHENOMENA OF FEVER 



VOL. III. 



OUTLINES 



OF THE 



PHENOMENA OF FEVER. 



AS many of the diseases which are the subjects of these 
volumes belong to the class of fevers, the following remarks 
upon their phenomena are intended to render the principles 
and language I have adopted, in the history of their causes, 
symptoms, and cure, intelligible to the reader. 

I am aware that these outlines will suffer by being pub- 
lished in a detached state from the general view of the 
proximate cause of disease which I have taught in my 
lectures upon pathology, as well as from its being deprived 
of that support which it would receive from being accom- 
panied with an account of the remedies for fever, and the 
times and manner of exhibiting them, all of which would 
have served to illustrate and establish the facts and reason- 
ings which are to follow upon this difficult and interesting 
inquiry. 

I shall not attempt to give a definition of fever. It 
appears in so many different forms, that a just view of it 
can only be given in minute detail of all of its symptoms 
and states. 

In order to render the outlines of fever, which I am 
about to deliver, more simple and intelligible, it will be 
necessary to premise a few general propositions, 

I. Fevers of all kinds are preceded by general debility. 
This debility is natural or accidental. The former is the 
effect of the sanguineous predisposition, and exists at all 
times in many constitutions. The latter is induced, 

1. By such preternatural or unusual stimuli, as, after 
first elevating the excitement of the system above its heal- 
thy grade, and thereby wasting a part of its strength, or 
what Dr. Brown calls excitability, and Darwin sensorial 
power, afterwards reduces it down to that state which I 
shall call debility of action. Or, 



a.m. ... 



4 OUTLINES OF THE 

2. It is induced by such an abstraction of natural 
stimuli as to reduce the system below its healthy grade of 
excitement, and thereby to induce what Dr. Brown calls 
direct debility, but what I shall call debility, from abstrac- 
tion. This general debility is the same, whether brought 
on by the former or the latter causes. When induced by 
the latter, the system becomes more excitable than when 
induced by the former causes, and hence an attack of fever 
is more frequently invited by it, than by that state of debi- 
lity which succeeds the application of an undue portion of 
stimulating powers. To this there is an exception, and 
that is, when the remote causes of fever, act with so much 
force and rapidity as suddenly to depress the system, with- 
out an intermediate elevation of it, and before sufficient 
time is given to expend any part of its strength or excita- 
bility, or to produce the debility of action. The system 
in this state, is exactly similar to that which arises from a 
sudden reduction of its healthy excitement, by the abstrac- 
tion of stimuli. This debility from abstraction, moreover, 
is upon a footing with the debility from action, when it is 
of a chronic nature. They both alike expend so much of 
the quality or substance of excitability, as to leave the 
system in a state in which irritants are seldom able to ex- 
cite the commotions of fever, and when they do, it is of a 
feeble nature, and hence we observe persons who have been 
long exposed to debilitating causes of both kinds, often 
escape fevers, while those who are recently debilitated, are 
affected by them, under the same circumstances of expo- 
sure to those causes. 

That fevers are preceded by general debility I infer from 
their causes, all of which act by reducing the excitement 
of the system, by the abstraction of stimuli, or by their 
excessive or unusual application. The causes which 
operate in the former way are, 

1. Cold. This is universally acknowledged to be a pre- 
disposing cause of fever. That it debilitates, I infer, 1. 
From the languor which is observed in the inhabitants of 
cold countries, and from the weakness which is felt in 
labour or exercise in cold weather. 2. From the effects of 
experiments, which prove, that cold air and cold water 
lessen the force and frequency of the pulse. 

2. The debilitating passions of fear, grief, and despair. 



PHENOMENA OF FEVER. 5 

3. All excessive evacuations, whether by the bowels, 
blood-vessels, pores, or urinary passages. 

4. Famine, or the abstraction of the usual quantities of 
nourishing food. 

The causes which predispose to fever by the excessive 
or unusual application of stimuli are, 

1. Heat. Hence the greater frequency of fevers in warm 
climates, and in warm weather. 

2. Intemperance in eating and drinking. 

3. Unusual labour or exercise. 

4. Violent emotions, and stimulating passions of the 
mind. 

5. Certain causes which act by over-streaching a part, 
or the whole of the body, such as lifting heavy weights, 
external violence acting mechanically in wounding, bruis- 
ing, or compressing particular parts, extraneous substances 
acting by their bulk or gravity, burning, and the like.* 
The influence of debility in predisposing to fevers is fur- 
ther evident from their attacking so often in the night, a 
time when the system is more weak than at any other, in 
the four and twenty hours. 

II. Debility being thus formed in the system, by the 
causes which have been enumerated, a sudden accumula- 
tion of excitability takes place, whereby a predisposition is 
created to fever. The French writers have lately called 
this predisposition " vibratility," by which they mean a 
liableness in it to be thrown into vibrations or motions, 
from pre-existing debility. It is not always necessary that 
a fever should follow this state of predisposition. Many 
people pass days and weeks under it, without being attack- 
ed by a fever, by carefully or accidentally avoiding the ap- 
plication of additional stimuli or irritants to their bodies : 
but the space between this state of predisposition, when it 
is recent, and a fever, is a very small one ; for, indepen- 
dently of additional stimuli, the common impressions which 
support life sometimes become irritants, and readily add 
another link to the chain of causes which induce fever, and 
that is, 

III. Depression of the whole system, or what Dr. Brown 
calls indirect debility. It manifests itself in weakness 
of the limbs, inability to stand or walk without pain, 

* Cnllen's First Lines. 



6 OUTLINES OP THE 

or a sense of fatigue, a dry, cool, or cold skin, chilliness, a 
shrinking of the hands and face, and a weak or quick pulse. 
These symptoms characterize part of what I have called m 
my lectures the forming state of fever. It is not necessary 
that a paroxism of fever should follow this depressed state 
of the system, any more than the debility that has been de- 
scribed. Many people, by rest, or by means of gentle 
remedies, prevent its formation ; but where these are neg- 
lected, and the action of stimuli, whether morbid or natu- 
ral, are continued, 

IV. Re-action is induced, and in this re-action, accord- 
ing to its greater or less force and extent, consist the dif- 
ferent degrees of fever. It is of an irregular or a convulsive 
nature. In common cases, it is seated primarily in the 
blood-vessels, and particularly in the arteries. These per- 
vade every part of the body. They terminate upon its 
whole surface, in which I include the lungs and alimentary 
canal, as well as the skin. They are the out posts of the 
system, in consequence of which they are most exposed to 
cold, heat, intemperance, and all the other external, and ex- 
ternal remote and exciting causes of fever, and are first rous- 
ed into resistance by them. 

Let it not be thought, from these allusions, that I admit 
Dr. Cullen's supposed vires naturae medicatrices to have 
the least agency in this re-action of the blood-vessels. I 
believe it to be altogether the effect of their elastic and 
muscular texture, and that it is as simply mechanical as 
motion from impressions upon other kinds of matter. 

That the blood vessels possess muscular fibres, and that 
their irritability or disposition to motion depends upon 
them, has been demonstrated by Dr. Vasschuer and Mr. 
John Hunter, by many experiments. It has since been 
proved by Spallanzani, in an attempt to refute it. Even 
Dr. Haller, who denies the muscularity and irritability of 
the blood-vessels, implies an assent to them in the follow- 
ing words : " There are nerves which descend for a long 
way together through the surface of the artery, and at last 
vanish in the cellular substance of the vessel, of which we 
have a specimen in the external and internal carotids, and 
in the arch of the aorta ; and from these do not the arteries 
seem to derive a muscular and convulsive force very dif- 
ferent from that of their simple elasticity ? Does not it show 



PHENOMENA OF FEVER. 7 

itself plainly in fevers, faintings, palsies, consumptions, and 
passions of the mind ?"* 

The re-action or morbid excitement of the arteries dis- 
covers itself in preternatural force, or frequency in their 
pulsations. In ordinary fever, it is equally diffused through- 
out the whole sanguiferous system, for the heart and arte- 
ries are so intimately connected, that, like the bells of the 
Jewish high priest, when one of them is touched, they all 
vibrate in unison with each other. To this remark there 
are some exceptions. 

1. The arteries are sometimes affected with great morbid 
excitement, while the natural functions of the heart are un- 
impaired. This occurs in those states of fever in which 
patients are able to sit up, and even to walk about, as in 
pulmonary consumption, and in hectic fever from all its 
causes. 

2. The heart and pulmonary artery are sometimes af- 
fected with great morbid excitement, while the pulsations 
of the arteries on the wrist are perfectly natural. 

3. The morbid excitement of the arteries is sometimes 
greater on one side of the body than on the other. This is 
obvious in the difference in the number and force of the 
pulsations in the different arms, and in the different and op- 
posite appearances of the blood drawn from their veins, 
under equal circumstances. 

4. The arteries in the head, lungs, and abdominal visce- 
ra are sometimes excited in a high degree, while the arte- 
ries in the extremities exhibit marks of a feeble morbid 
action. Fevers attended with these and other deviations 
from their common phenomena, have been called by Dr. 
Alibert, altaxiques. They occur most frequently in ma- 
lignant fevers. 

While morbid excitement thus pervades generally or 
partially the sanguiferous system, depression and debility 
are increased in the alimentary canal, and in the nervous 
and muscular systems. In the stomach, bowels, and 
muscles, this debility is occasioned by their excitement 
being abstracted, and translated to the blood-vessels. 

I shall now endeavour to illustrate the propositions which 
have been delivered, by taking notice of the manner in 

* First Lines, sect. 32. of the chapter on Arteries. 



8 OUTLINES OF THE 

which fevers are produced by some of their most obvious 
and common causes. 

Has the body been debilitated by exposure to the cold 
air ? Its excitability is thereby increased, and heat acts 
upon it with an accumulated force : hence the frequency 
of catarrhs, pleurisies, and other inflammatory fevers in the 
spring, after a cold winter : and of bilious remittents in the 
autumn, when warm days succeed to cold and damp nights. 
These diseases are seldom felt for the first time in the open 
air, but generally after the body has been exposed to cold, 
and afterwards to the heat of a warm room or a warm bed. 
Mild intermittents have frequently been observed to acquire 
an inflammatory type in the Pennsylvania hospital, in the 
months of November and December, from the heat of the 
stove rooms acting upon bodies previously debilitated and 
rendered excitable by cold and disease. 

Has there been an abstraction of heat by a sudden shift- 
ing of the wind from the south-west to the north-west or 
north-east points of the compass, or by a cold night suc- 
ceeding a warm day ? a fever is thereby frequently excit- 
ed. These sources of fever occur every autumn in Phi- 
ladelphia. The miasmata which exists in the body at that 
time in a harmless state, are excited into action, in a man- 
ner to be mentioned presently, by the debility from cold, 
aided in the latter case by the inaction of sleep, suddenly 
induced upon the system. 

Again : has the body been suddenly debilitated by la- 
bour or exercise? Its excitement is thereby diminished, 
but its excitability is increased in such a manner that a full 
meal, or an intemperate glass of wine, if taken immediately 
after the fatigue is induced upon the body, excites a fever: 
hence the frequency of fevers in persons upon their return 
from hunting, surveying, long rides, or from a camp life. 

But how shall we account for the production of fever 
from the measles and small-pox, which attack so uniform- 
ly, and without predisposing debility from any of its causes 
which have been enumerated ? I answer, that the conta- 
gions of those diseases seldom act so as to produce fever, 
until the system is first depressed. This is obvious from 
their being preceded by languor, and all the other symp- 
toms formerly mentioned, which constitute the forming 
state of fever. The miasmata which induce the plague and 






PHENOMINA OF FEVER. 



yellow fever, when they are not preceded by the usual de- 
bilitating and predisposing causes, generally induce the 
same depression of the system, previously to their exciting 
fever. Even wounds, and other local irritants seldom in- 
duce fever before they have first produced the symptoms 
of depression formerly mentioned. I shall presently men- 
tion the exceptions to this mode of producing fever from 
contagious miasmata and local injuries, and show that they 
do not militate against the truth of the general proposition 
that has been delivered. 

It may serve still further to throw light upon this part of 
our subject to take notice of the difference between the ac- 
tion of stimuli upon the body predisposed by debility and 
excitability to fever, and their action upon it when there is 
no such predisposition to fever. 

In health there is a constant and just proportion between 
the degrees of excitement and excitability, and the force of 
stimuli. But this is not the case in a predisposition to a 
fever. The ratio between the action of stimuli and excite- 
ment, and excitability is destroyed ; and hence the former 
act upon the latter with a force which produces irregular 
action, or a convulsion in the arterial system. When the 
body is debilitated, and its excitability increased, either by 
fear, darkness, or silence, a sudden noise occasions a short 
convulsion. We awake, in like manner, in a light convul- 
sion, from the sudden opening of a door, or from the sprink- 
ling of a few drops of water in the face, after the excitabili- 
ty of the system has been accumulated by a night's sleep. 
In a word, it seems to be a law of the system, that stimu- 
lus, in an over-proportion to excitability, either produces 
convulsion, or goes so for beyond it, as to destroy motion 
altogether in death. 

V. There is but one exciting cause of fever, and that is 
stimulus. Heat, alternating with cold,* marsh and human 
miasmata, contagions and poisons of all kinds, intempe- 
rance, passions of the mind, bruises, burns, and the like, all 
act by a stimulating power only, in producing fever. This 
proposition is of great application, inasmuch as it cuts the 

* Perhaps there is no greater enemy to the life of man than cold. Dr. 
Sydenham ascribes nearly all fevers to it, particularly to leaving off win- 
ter clothes too soon, and to exposing the hody to cold after it has been 
heated. These sources of fever, he adds, destroy more than the plague, 
sword, or famine. — M'allix's edition, vol. i. p. 357. : 

VOL. III. B 



10 OUTLINES OF THE 

sinews of the division of diseases from their remote causes. 
Thus it establishes the sameness of a pleurisy, whether it be 
excited by heat succeeding cold, or by the contagions of 
the small-pox and measles, or by the miasmata of the yel- 
low fever. 

To this proposition there is a seeming objection. Cold> 
sleep, immoderate evacuations, and the debilitating passions 
of grief and fear (all of which abstract excitement) appear 
to induce fever without the interposition of a stimulus. In 
all these cases, the sudden abstraction of excitement destroys 
the equilibrium of the system, by which means the blood 
is distributed unequally, and by acting with an increase of 
quantity and force in parts not accustomed to either, be- 
comes an irritant to the blood-vessels, and thus a stimulat- 
ing and exciting cause of fever. When it is induced by 
cold alone, it is probable so much of the perspirable matter 
may be retained as to co-operate, by its irritating qualities, 
in exciting the fever. 

VI. There is but one fever. However different the pre- 
disposing, remote, or exciting causes of fever may be, 
whether debility from abstraction or action, whether heat 
or cold succeeding to each other, whether marsh or human 
miasmata, whether intemperance, a fright, or a fall, still I 
repeat, there can be but one fever. I found this proposi- 
tion upon all the supposed variety of fevers having but one 
proximate cause. Thus fire is a unit, whether it be pro- 
duced by friction, percussion, electricity, fermentation, or 
by a piece of wood or coal in a state of inflammation. I 
infer the unity of fever further, from the sameness of the 
products or effects of all its different forms. 

VII. All ordinary fever being seated in the blood-vessels, 
it follows, of course, that all those local affections we call 
pleurisy, angina, phrenitis, internal dropsy of the brain, 
pulmonary consumption, and inflammation of the liver, 
stomach, bowels, and limbs, are symptoms only of an ori- 
ginal and primary disease in the sanguiferous system. The 
the truth of this proposition is obvious from the above local 
affections succeeding primary fever, and from their alter- 
nating so frequently with each other, I except from this 
remark those cases of primary affections of the viscera 
which are produced by local injuries, and which, after a 
while, bring the whole sanguiferous system into sympathy. 



PHENOMENA OF FEVER. 11 

These cases are uncommon, amounting, probably, to not 
more than one in a hundred of all the cases of local affection 
which occur in general fever. 

In my fourth proposition I have called the action of the 
arteries irregular in fever, to distinguish it from that excess 
of action which takes place after violent exercise, and from 
that quickness which accompanies fear or any other directly 
debilitating cause. The action of the arteries here is regu- 
lar, and, when felt in the pulse, affords a very different sen- 
sation from that jerking which we feel in the pulse of a 
patient labouring under a fever. 

In my lectures upon pathology, in which I have main- 
tained the unity of disease, I have said that it appears in 
one or more of the following primary forms. 1. Spasm,, 
2. Convulsion, 3. Heat, 4. Itching, 5. Aura dolorifica, 
and, 6. Suffocated excitement. In ordinary fever, the 
second form of morbid excitement, that is convulsion, 
takes place in the blood-vessels. That this is the case I 
infer from the strict analogy between symptoms of fever, 
and convulsions in the nervous system. I shall briefly 
mention the particulars in which this analogy takes place. 

1. Are convulsions in the nervous system preceded by 
debility ? So is the convulsion of the blood-vessels in fever. 

2. Does debility induced on the whole or on a part only, 
of the nervous system, predispose to general convulsions, 
as in tetanus ? So we observe debility, whether it be indu- 
ced on the whole or on a part of the arterial system, predis- 
poses to general fever. This is obvious in the fever which 
ensues alike from cold applied to every part of the body, 
or from a stream of cold air falling upon the neck, or from 
the wetting of the feet. 

3. Do tremors precede convulsions in the nervous sys- 
tem ? So they do the convulsion of the blood-vessels in 
fever. 

4. Is a coldness in the extremities a precursor of con- 
vulsions in the nervous system ? So it is of fever. 

5. Do convulsions in the nervous system impart a jerk- 
ing sensation to the fingers ? So does the convulsion of 
lever in the arteries, when felt at the wrists. 

6. Are convulsions in the nervous system attended with 
alternate action and remission ? So is the convulsion of" 
fever. 



12 OUTLINES OF THE 

7. Do convulsions in the nervous system return at re- 
gular and irregular periods ? So does fever. 

8. Do convulsions in the nervous system, under certain 
circumstances, affect the functions of the brain ? So do 
certain states of fever. 

9. Are there certain convulsions in the nervous system 
which affect the limbs, without affecting the functions of 
the brain, such as tetanus, and chorea sancti viti ? So there 
are certain fevers, particularly the common hectic, which 
seldom produces delirium, or even head-ach, and frequent- 
ly does not confine a patient to his bed. 

10. Are there local convulsions in the nervous system, 
as in the hands, feet, neck, and eye-lids? So there are local 
fevers. Intermittens often appear in the autumn with pe- 
riodical heat and pains in the eyes, ears, jaws, and back. 

11. Are there certain grades in the convulsions of the 
nervous system, as appears in the hydrophobia, tetanus, 
epilepsy, hysteria, and hypocondriasis ? So there are grades 
in fevers, as in the plague, yellow fever, small-pox, rheu- 
matism, and common remitting and intermitting fevers. 

12. Are nervous convulsions most apt to occur in in- 
fancy ? So are fevers. 

.13. Are persons once affected with nervous convulsions 
frequently subject to them through life ? So are persons 
once affected with fever. The intermitting fever often re- 
turns with successive springs or autumns, and, in spite of 
the bark, sometimes continues for many years in all cli- 
mates and seasons. 

14. Is the strength of the nervous system increased by 
convulsions ? This is so evident that it often requires four 
or five persons to confine a delicate woman to her bed in a 
convulsive fit. In like manner the strength of the arterial 
system is increased in a fever. This strength is great in 
proportion to the weakness of every other part of the body. 

15. Do we observe certain nervous convulsions to affect 
some part of the nervous system more than others, or, in 
other words, do we observe preternatural strength or ex- 
cit . ment to exist in one part of the nervous system, while 
other parts of the same system exhibit marks of preternatu- 
ral weakness or defect of excitement ? We observe the 
same thing in the blood-vessels in a fever. The pulse at 
the wrist is often tense, while the force of the heart is very 



PHENOMENA OF FEVER. 13 

much diminished. A delirium often occurs in a fever from 
excess of excitement in the blood-vessels of the brain, while 
the pulse at the wrist exhibits every mark of preternatural 
weakness. 

16. Is there a rigidity of the muscles in certain nervous 
diseases, as in catalepsey ? Something like this solstice in 
convulsion occurs in that state of fever in which the pulse 
beats but sixty, or fewer strokes in a minute. 

17. Do convulsions go off gradually from the nervous 
system, as#n tetanus, and chorea sancti viti? So they do 
from the arterial blood-vessels in certain states of fever. 

18. Do convulsions go off suddenly in any cases from 
the nervous system ? The convulsion in the blood-vessels 
goes off in the same manner by a sweat, or by a haemorrh- 
age, frequently in the course of a night, and sometimes in 
a single hour. 

19. Does palsy in some instances succeed to convulsions in 
the nervous system? Something like a palsy occurs in fevers 
of great inflammatory action in the arteries. They are often 
inactive in the wrists, and in other parts of the body, from the 
immense pressure of the remote cause of the fever upon them. 

Fro«a the facts and analogies which have been mention- 
ed, I have been led to conclude that the common forms of 
fever are occasioned simply by irregular action, or convul- 
sion in the blood-vessels. This irregular action is of two 
kinds. The first is seated in the muscular fibres of the 
blood-vessels themselves ; the second consists in an irregu- 
lar distribution of the blood to different parts of the body, 
particularly to the brain, lungs, liver and spleen. 

The history of the phenomena of fever, as delivered in 
the foregoing pages, resolves itself into a chain, consisting 
of the five following links. 

1. Debility from action, or the abstraction of stimuli. 
When this debility is induced by action, it is sometimes 
preceded by elevated excitement in the blood-vessels, from 
the first impressions of stimuli upon them. 

2. An increase of their excitability. 

3. Stimulating powers applied to them. 

4. Depression. And, 

5. Irregular action or convulsion. 

The whole of the links of this chain are perceptible only 
when the fever comes on in a gradual manner. But I wish 



L4 OUTLINES OF THE 

the reader to remember, that the same remote cause is often 
debilitating, stimulating, and depressing, and that, in cer- 
tain fevers, the remote cause sometimes excites convul- 
sions in the blood-vessels without being preceded by pre- 
ternatural debilitv and excitability, and with but little or 
no depression of 'the system. This has often been observ- 
ed in persons who have been suddenly exposed to those 
marsh and human miasmata which produce malignant fe- 
vers. It sometimes takes place likewise in fevers induced 
by local injuries. The blood-vessels in these (Uses are, as 
it were, taken by storm, instead of regular approaches. 

I might digress here, and show that all diseases, whether 
they be seated in the arteries, muscles, nerves, brain, or 
alimentary canal, are all preceded by debility; and that 
their essence consists in irregular action, or in the absence 
of the natural order of motion, produced or invited by pre- 
disposing debility. I might further show, that all the 
moral, as well as physical evil of the world consists in pre- 
disposing weakness, and in subsequent derangement of 
action or motion ; but these collateral subjects are foreign 
to our present inquiry. 

Let us now proceed to examine how far the facts^vhich 
have been delivered accords with the phenomena of fever. 

I shall divide these phenomena into two kinds. 

I. Such as are transient, and more or less common to all 
fevers. These I shall call symptoms of fever. 

II. Such as, being more permanent and fixed, have 
given rise to certain specific names. These I shall call 
states of fever. 

I shall endeavour to explain and describe each of them 
in the order in which they have been mentioned. 

I. Lassitude is the effect of the depression of the whole 
system, which precedes fever. 

The same cause, when it acts upon the extremities of 
the blood-vessels, produces coldness and chills. This is 
obvious to any person, under the first impression of the 
miasmata which bring on fevers, also under the influence 
of fatigue, and debilitating passions of the mind. The 
absence of chills indicates the sensibility of the external 
parts of the body to be suspended or destroyed, as well as 
their irritability ; hence when death occurs in the fit of an 
intermittent, there is no chill. A chilly fit, for the sarn^ 



PHENOMENA OF FEVER. 15 

reason, seldom occurs in the most malignant case's offerer. 

It is sometimes excited by blood-letting, only because 
it weakens those fevers to such a degree, as to carry the 
blood-vessels back to the grade of depression. Coldness 
and chills are likewise removed by blood-letting, only be- 
cause it enables the arteries to re-act in such a manner as 
to overcome the depression that induced it. It has been 
remarked, that the chilly fit, an common fevers, seldom 
appears in its full force until the patient approaches a fire, 
or lies down on a warm bed ; for in these situations sensi- 
bility is restored by the stimulus of the heat acting upon 
the extremities of the blood-vessels. The first impres- 
sions of the rays of the sun, in like manner, often produce 
coldness and chills in the torpid bodies of old and weakly 
people. 

Yawning and stretching are induced by a disposition in 
the system to overcome the uneasiness which arises from 
the contraction of the fauces, trachea, oesophagus and skin. 

Tremors are the natural consequence of the abstraction 
of that support which the muscles receive from the fulness 
and tension of the blood-vessels. It is from this retreat of 
the blood towards the viscera, that the capillarya rteries lose 
their fulness and tension ; hence they contract like other 
soft tubes that are emptied of their contents. This con- 
traction has been called a spasm, and has improperly been 
supposed to be the proximate cause of fever. From the 
explanation that has been given of its cause, it appears, 
like the coldness and chills, to be nothing but an accidental 
concomitant, or effect of a paroxysm of fever. 

The local pains in the head, breast, and bones in fever, 
appear to be the effects of the. irregular determination of 
the blood to those parts, and to mQrbicl action being thereby 
induced in them. 

The want of appetite and costiveness are the consequen- 
ces of a defect of secretion of the gastric juice, and the 
abstraction of excitement or natural action from the sto- 
mach and bowels. 

The inability to rise out of bed, and to walk, is the 
effect of the abstraction of excitement from the muscles 
of the lower limbs. 

The dry skin or partial sweats appear to depend upon 



16 OUTLINES OF THE 

diminished or partial action in the vessels which terminate 
on the surface of the body. 

The high-coloured and pale urine are occasioned by an 
excess or a deficiency of excitement in the secretory ves- 
sels of the kidneys. 

The suppression of the urine seems to arise from what 
Dr. Clark calls an engorgement, or choaking of the ves- 
sels of the kidneys. It occurs most frequently in malig- 
nant fevers. 

Thirst is probably the effect of a preternatural excite- 
ment of the vessels of the fauces. It is by no means a 
uniform symptom of fever. We sometimes observe it, in 
the highest degree, in the last stage of diseases, induced 
by the retreat of the last remains of excitement from every 
part of the body, to the throat. 

The white tongue is produced by a change in the se- 
cretion which takes place in that organ. Its yellow colour 
is the effect of bile ; its dryness is occasioned by an ob- 
struction of secretion, or by the want of action in the 
absorbents ; and its dark and black colour, by a tendency 
to mortification. 

It will be difficult to account for the variety in the de- 
grees and locality of heat in the body in a fever, until we 
know more of the cause of animal heat. From whatever 
cause it be derived, its excess and deficiency, as well as all 
its intermediate degrees, are intimately connected with more 
or less excitement in the arterial system. It is not neces- 
sary that this excitement should exist only in the large 
blood-vessels. It will be sufficient for the purpose of creat- 
ing great heat, if it occur only in the cutaneous vessels ; ' 
hence we find a hot skin in some cases of malignant fever 
in which there is an absence of pulse. It is a singular 
fact, that when the heat of the body is 12° and 13° above 
its natural temperature, patients have sometimes a sensation 
of cold. This is taken notice of by Dr. De Haen and 
Dr. Haller. It is a fact likewise, that the body is sometimes 
cold, without the patient being sensible of it. The sensa- 
tion of cold is said by Dr. Grimaud to be different in dif- 
ferent forms of fever. In catarrh, and quotian and quar- 
tian fevers, the sensation he says is the same as that of cold 
air applied to the body ; while in tertian and bilious fevers, 
the sensation resembles that which is excited by sharp 



PHENOMENA OF FEVER. 17 

points being thrust into the skin. Is there an increase in 
the quantity of heat in the whole body in a fever ? Or is 
it, like excitement, only distributed unequally? Experi- 
ments alone can determine this question. 

Eruptions seem to depend upon effusions of serum, 
lymph, or red blood upon the skin, with or without inflam- 
mation, in the cutaneous vessels. 

I decline taking notice in this place of the symptoms 
which are produced by the debility from action and abstrac- 
tion, and by the depression of the system. They appear 
not only in the temperature of the body, but in all the dif- 
ferent symptoms of fever. It is of importance to know 
when they originate from the former, and when from the 
latter causes, as they sometimes require very different and 
opposite remedies to remove them. 

It remains only to explain the cause why excess in the 
force or frequency of the action of the blood-vessels should 
succeed debility in a part, or in the whole of the body, 
and be connected for days and weeks with depression and 
preternatural debility in the nerves, brain, muscles, and 
alimentary canal. I shall attempt the explanation of this 
phenomenon by directing the attention of the reader to the 
operations of nature in other parts of her works. 

1. A calm may be considered as a state of debility in 
the atmosphere. It predisposes to a current of air. But 
is this current proportioned to the loss of the equilibrium 
of the air ? By no means. It is excessive in its force, and 
tends thereby to destroy the works both of nature and art. 

2. The passions are given to man on purpose to aid the 
slow and uncertain operations of reason. But is their 
action always proportioned to the causes which excite them? 
An acute pneumony, brought on by the trifling injury done 
to the system by the fatigue and heat of an evening spent 
in a dancing assembly, is but a faint representation of the 
immense disproportion between a trifling affront, and that 
excess of passion which seeks for gratification in poison, 
assassination, or a duel. The same disproportion appears 
between cause and effect in public bodies. A hasty word, 
of no mischievous influence, has often produced convul- 
sions, and even revolutions, in states and empires. 

If we return to the human body we shall find in it many 
other instances of the disproportion between stimulus and 

VOL. III. c 



18 OUTLINES OF THE 

action, besides that which takes place in the excitement of 
fever. 

3. A single castor oil nut, although rejected by the sto- 
mach upon its first effort in vomiting, has, in one instance 
that came within my knowledge, produced a vomiting that 
continued nearly four and twenty hours. Here the duration 
of action was far beyond all kind of proportion to the cause 
which excited it. 

4. A grain of sand, after being washed from the eye, is 
often followed by such an inflammation or excess in the 
action of the vessels of the eye, as to require bleeding, 
purging, and blistering to remove it. 

Could we comprehend every part of the sublime and 
ineffable system of the divine government, I am sure we 
should discover nothing in it but what tended ultimately 
to order. But the natural, moral, and political world ex- 
hibit every where marks of disorder, and the instruments 
of this disorder, are the operations of nature. Her influ- 
ence is most obvious in the production of diseases, and 
in her hurtful or ineffectual efforts to remove them.* In 
again glancing at this subject I wish it to be remembered 
that those operations were not originally the means of in- 
juring or seducing man, and that I believe a time will come 
when the exact relation between cause and effect, or, in 
other words, the dominion of order shall be restored over 
every action of his body and mind, and health and happi- 
ness again be the result of every movement of nature. 

From the view I have given' of the state of the blood- 
vessels in fever, the reader will perceive the difference be- 
tween my opinions and Dr. Brown's upon this subject. 
The doctor supposes a fever to consist in debility. I do 
not admit debility to be a disease, but place it wholly in 
morbid excitement, invited and fixed by previous debility. 
He makes a fever to consist in a change only of a natural 
action of blood-vessels. I maintain that it consists in a 
preternatural and convulsive action of the blood-vessels. 
Lastly, Dr. Brown supposes excitement and excitability 
to be equally diffused over the whole bodv, but in unheal- 
thy proportions to each other. Mv theory places fever in 
excitement and excitability unequally diffused, manifeting 

e^&ssp^r- View of the Diseases ° f the indi - s * « f 



PHENOMENA OF FEVER. 19 

themselves, at the same time, in morbid actions, depression, 
and debility from abstraction, in different parts of the body. 
No new excitement from without is infused into the system 
by the irritants which excite a fever. They only destroy 
its equal and natural distribution ; for while the arteries are 
in a plus, the muscles, stomach, and bowels are in a minus 
state of excitement, and the business of medicine is to 
equalize it in the cure of fever, that is, to abstract its ex- 
cess from the blood-vessels, and to restore it to the other 
parts of the body. 

II. I come now to apply what has been delivered to the 
explanation and description of the different phenomena or 
states of fever. 

I have said in my six h proposition that there is but one 
fever. Of course 1 ao not admit of its artificial division 
into genera and species. A disease which so frequently 
changes its form and place, should never have been desig- 
nated, like plants and animals, by unchangeable characters. 
The oak tree and the lion possess exactly the same proper- 
ties which they did nearly 6000 years ago. But who can 
say the same thing of any one disease ?' The pulmonary 
consumption is sometimes transformed into a head-ach, 
rheumatism, diarrhoea, and mania, in the course of two or 
three months, or the same number of weeks. The bilious 
fever often appears in the same person in the form of colic, 
dysentery, inflammation of the liver, lungs, and brain, in 
the course of live or six days. The hypochondriasis and 
the hysteria seldom fail to exchange their symptoms twice 
in the four and twenty hours. Again : the oak tree has not 
united with any of the trees of the forest, nor has the lion 
imparted his specific qualities to any other animal. But 
who can apply similar remarks to any one disease ? Phre- 
nitis, gastritis, enteritis, nephritis, and rheumatism all ap- 
pear at the same time in the gout and yellow fever. Many 
observations of the same kind might be made, to show the 
disposition of nearly all other diseases to anastomose with 
each other. To describe them therefore by any fixed or 
specific characters is as impracticable as to measure the di- 
mensions of a cloud on a windy day, or to fix the compo- 
neht parts of water by weighing it in a hydrostatic balance. 
Much mischief has been done by nosological arrangements 
of diseases. They erect imaginary boundaries between 



20 outlines or tul 

things which are of a homogeneous nature. They degrade 
the human understanding, by substituting simple percep- 
tions to its more dignified operations in judgment and rea- 
soning. They gratify indolence in a physician, by fixing 
his attention upon the name of a disease, and therebyjead- 
ing him to neglect the varying state of the system. They 
moreover lay a foundation for disputes among physicians, 
by diverting their attention from the simple, predisposing, 
and proximate, to the numerous, remote, and exciting 
causes of diseases, or to their more numerous and compli- 
cated efFects. The whole materia medic a is infected with 
the baneful consequences of the nomenclature of diseases, 
for every article in it is pointed only against their names, 
and hence the origin of the numerous contradictions among 
authors who describe the virtues and doses of the same 
medicines. By the rejection of the artificial arrangement 
of diseases, a revolution must follow in medicine. Obser- 
vation and judgment will take the place of reading and 
memory, and prescriptions will be conformed to existing 
circumstances. The road to knowledge in medicine by 
this means will likewise be shortened ; so that a young man 
will be able to qualify himself to practice physic at as much 
less expense of time and labour than formerly, as a child 
would learn to read and write by the help of the Roman 
alphabet, instead of Chinese characters. 

In thus rejecting the nosologies of the schools, I do not 
wish to see them banished from the libraries of physicians. 
When consulted as histories of the effects of diseases 
only, they may still be useful. I use the term diseases, in 
conformity to custom, for, properly speaking, disease is as 
much a unit as fever. It consists "simply of morbid action 
or excitement in some part of the body. Its different seats 
and degrees should no more be multiplied into different 
diseases, than the numerous and different effects of heat and 
light upon our globe should be multiplied into a plurality 
of suns. 

The advocates for Dr. Culksfs system of medicine, will 
not, I hope, be offended by these observations. His im- 
mense stock of reputation will enable him to sustain the 
loss of his nosology without being impoverished by it In 
my attempts to introduce a new'arrangement of fevers, 1 



PHENOMENA OF FEVER. 21 

shall only give a new direction to his efforts to improve the 
healing art. 

Were it compatible with the subject of the present inquiry, 
it would be easy to show, that the same difficulties and evils 
are to be expected from Dr. Darwin's division of diseases, 
as they affect the organs of sensation and motion, and as 
they are said to be exclusively related by association and 
volition, that have been deprecated from their divisions and 
subdivisions by the nosologists. Diseases, like vices, with 
a few exceptions, are necessarily undisciplined and ir- 
regular. Even the genius of Dr. Darwin has not been able 
to compel them to move within lines. 

I return from this digression to remark, that morbid ac- 
tion in the blood-vessels, whether it consist in preternatural 
force and frequency, or preternatural force without frequen- 
cy, or frequency without force, constitutes fever. Excess 
in the force and frequency in the pulsations of the arteries 
have been considered as the characteristic marks of what is 
called inflammatory fever. There are, however, symptoms 
which indicate a much greater excess of irritating impres- 
sions upon the blood-vessels. These are preternatural slow- 
ness, intermissions, and depression in the pulse, such as 
occur in certain malignant fevers. 

But there is a grade of fever, which transcends in force 
that which produces inflammation. It occurs frequently 
in hydrophobia, dysentery, colic, and, baron Humboldt 
lately informed me, upon the authority of Dr. Comoto, of 
Vera Cruz, in the yellow fever of that city, when it proves 
fatal in a few hours after it attacks. In vain have physi- 
cians sought to discover, by dissections, the cause of fever 
in those cases, when followed by death, in the parts of the 
body in which it was supposed, from pain and other symp- 
toms, to be principally seated. Those parts have frequent- 
ly exhibited no marks of inflammation, nor of the least de- 
viation from a healthy state. I have ascribed this apparent 
absence of disease to the serous vessels being too highly 
excited, and thereby too much contracted, to admit the en- 
trance of red blood into them. I wish these remarks to be 
remembered by the student of medicine. They have de. 
livered mc from the influence of several errors in pathologv; 
and they are capable, if properly extended and applied, of 



22 OUTLINES OF THE 

leading to many important deductions in the practice of 

physic. 

, I shall now briefly mention the usual effects of fever, or 

morbid excitement in the blood-vessels, when not removed 

by medicine. They are, 

1. Inflammation. It is produced by an effusion of red 
particles of blood into serous vessels, constituting what Dr. 
.Boerhaave calls error loci. It is the second grade of fever, 
and, in lexers of great violence, does not take place until 
morbid excitement has continued for some time, or has 
been reduced l:w bleeding. 

2. Secretion, or an effusion from rupture, of the serum 
of the blood, constituting dropsies. Under this head I- in- 
clude hydatids, which are found in every part of the body, 
even in the heart. 

5. Secretion of lymph or fibrin, forming a membrane 
which adheres to certain surfaces in the body. 

4. Secretion of pus, sloughs, and of a black matter, in 
the stomach, liver, bowels, kidneys, and upon the skin. In 
the stomach it is called the " black vomit :" upon the skin 
it forms what are called carbuncles. 

5. An effusion by rupture, or a congestion of all the 
component parts of the blood. 

6. Gangrene from the death of the blood-vessels. 

7. Rupture of blood-vessels, producing haemorrhage. 

8. Redness, phlegmon, pustules, and petechias on the 
skin, and tubercles in the lungs, and on the liver and 
bowels. 

9. Air. How far this product of diseased action in the 
blood-vessels may extend to every part of the body, I know 
not. There can be no doubt of its being effused from the 
stomach and liver into the bowels, in the paroxysms of bil- 
ious fevers. 

10. Schirrus, cartilage and bone. 

11. Calcareous and other earthy matters. The two last 
take place only in the feeble and often imperceptible m-ades 
of morbid action in the blood-vessels. Different parts of 
the body are more or less disposed to produce the different 
products of fever that have been mentioned. 

12. Death. This arises from the following causes. 

1. Sudden destruction of the excitability of the blood- 
vessels. 



PHENOMENA OF FEVER. 23 

2. A disorganization of parts immediately necessary to 
life. 

3. A change in the fluids, so as to render them destruc- 
tive to what are called the vital organs. 

4. Debility, from the exhausted or suspended state of 
the excitability of the blood-vessels. 

All these effects of fever are different according to its 
grade. Dr. Blane says levers are rarely inflammatory in the 
West-Indies ; that is, they pass rapidly from simple mor- 
bid excitement to congestion, haemorrhage, gangrene, and 
death. This remark is confirmed by Dr. Dalzelle, who 
says the pneumony in the negroes, in the French West- 
India islands, rarely appears in any other form than that of 
the notha, from the arteries in the lungs being too much 
stimulated to produce common inflammation ; but such is 
the force of morbid excitement /in hot climates, that it 
sometimes passes suddenly over all its intermediate effects, 
and discovers itself only in death. This appears to have 
taken place in the cases at Vera Cruz, mentioned by baron 
Humboldt. The two extremes of morbid excitement 
seem to meet in a poinl, for we sometimes observe death 
to take plaee from a feeble typhus fever without leaving 
behind it any marks of inflammation or even serous effu- 
sion, in common with the violent grade of fever which has 
been described. 

All the different states of fever may be divided, 

I. Into such as affect the whole arterial system ; but 
with no, or very little local disease. 

II. Into such as affect the whole arterial system, and are 
accompanied at the same time with evident local disease. 

III. Into such as appear to pass by the arterial system, 
and to fix themselves upon other parts of the body. I shall 
call these states of fever misplaced. 

I. To the first elass of the states of fever belong, 
1. The maligiicmt. It constitutes the highest or worst 
grade of morbid diathesis. It is known by attacking fre- 
quently without a chilly fit, by coma, a depressed, slow, 
or intermitting pulse, and sometimes by the absence of 
pain, and with a natural temperature or coldness of the 
skin. It occurs in the plague, in the yellow fever, iu the 
gout, in the small-pox and measles, in the hydrophobia, 
and after taking opium and other stimulating substances. 



24 OUTLINES OF THE 

Dr. Quier has described a pleurisy in Jamaica, in which 
some of those malignant symptoms took place. They are 
the effect of such a degree of impression as to prostrate 
the arterial system, and to produce a defect of action from 
an excess of force. Such is this excess of force, in some 
instances, in this state of fever that it induces general con^ 
vulsions, tetanus, and palsy, and sometimes extinguishes 
life in a few hours, by means of apoplexy or syncope. 
From its being accompanied with these symptoms, it has 
received the name of adynanrique by Dr. Alibert. The 
less violent degrees of stimulus in this state of fever pro- 
duce palsy in the blood-vessels. It probably begins in the 
veins, and extends gradually to the arteries. It seems 
further to begin in the extremities of the arteries, and to 
extend by degrees to their origin in the heart. This is 
evident in the total absence of pulse which sometimes takes 
place in malignant fevers, four and twenty, and even eight 
and forty hours before death. But there are cases in which 
this palsy affects both the veins and arteries at the same 
time. It is probably from this simultaneous affection of 
the blood-vessels, that the arteries are found to be nearly 
full of blood after death from malignant fevers. The de- 
pressed, and intermitting pulse which occurs in the begin- 
ning of these fevers perhaps depends upon a tendency to 
palsy in the arteries, independently of an affection of the 
heart or brain. 

This prostrate state of fever more frequently when left 
to itself terminates in petechias, buboes, carbuncles, ab- 
scesses, and mortifications, according as serum, lymph, or 
red blood is effused in the viscera or external parts of the 
body. These morbid appearances have been ascribed to 
putrefaction, and the fever has received, from its supposed 
presence, the name of putrid. The existence of putrefac- 
tion in the blood in a fever is rendered improbable, 

1. By Dr. Seybert's experiments,* which prove that it 
does not take place in the blood in a living state. It occurs 
in the excretions of bile, fasces, and urine, but in this case 
it does not act as a ferment, but a stimulus only upon the 
living bodv. 

2. By similar appearances, with those which have been 

* Inaugural dissertation, entitled, " An Attempt to disprove the Putre- 
faction oi she Blood in Living Animals." 



PHENOMENA OF FEVER* 2$ 

ascribed to putrefaction, having been produced by light* 
ning, by violent emotions of the mind, by extreme pain, 
and by every thing else which induces sudden and univer- 
sal disorganization in the fluids and solids of the body* 
The following facts clearly prove that the symptoms which 
have been supposed to designate a putrid fever, are 
wholly the effect of mechanical action in the blood-vessels, • 
and are unconnected with the introduction of a putrid fer- 
ment in the blood. 

Hippocrates relates the case of a certain Antiphillus, in 
whom a putrid bilious fever (as he calls it) was brought on 
by the application of a caustic to a wound.* 

An acute pain in the eye, Dr. Physick informed me, pro- 
duced the symptoms of what is called a putrid fever, which 
terminated in death in five days, in St. -George's hospital, 
in the year 1789. 

Dr. Baynard relates, upon the authority of a colonel 
Bampfield, that a stag, which he had chased for some time, 
stopped at a brook of water in order to drink. Soon after- 
wards it fell and expired. The colonel cut its throat, and 
was surprised to perceive the blood which issued frcflh it 
had a putrid and offensive smell, f 

Dr. Desportes takes notice that a fish, which he calls a 
sucker, affected the system nearly in the same manner as 
the miasmata of the yellow fever. A distressing vomiting, 
a coldness of the extremities, and an absence of pulse, 
were some of the symptoms produced by it, and an inflam- 
mation and mortification of the stomach and bowels, were 
discovered after death to be the effects of its violent ope- 
ration. 

Even opium, in large doses, sometimes produces by its 
powerful stimulus the same symptoms which are produced 
by the stimulus of marsh miasmata. These symptoms are 
a slow pulse, coma, a vomiting, cold sweats, a sallow 
colour of the face, and a suppression of the discharges by 
the urinary passages and bowels. 

Error is often perpetuated by words- A belief in the 
putrefaction of the blo%i has done great mischief in medi- 
cine. The evil is kept up, under the influence of new the- 
ories, by the epithet putrid, which is still applied to fever 

* Epidemics, book iv. | Treatise on the Cold Bath. 

VOL. III. 6 



26 OUTLINES OF THE 

in all our medical books. For which reason I shall reject 
it altogether hereafter, and substitute in its room, 

2. The gangrenous state of fever ; for what appear to 
some physicians to be signs of putrefaction, are nothing but 
the issue of a violent inflammation left in the hands of na- 
ture, or accelerated by stimulating medicines. Thus the 
sun, when viewed at mid-day, appears to the naked eye, 
from the excess of its splendour, to be a mass of darkness, 
instead of an orb of light. 

The same explanation of what are called putrid symp- 
toms in fever, is very happily delivered by IVir. Hunter in 
the following words : " It is to be observed (says this acute 
physiologist) that when the attack upon these organs, which 
are principally connected with life, proves fatal, that the 
effects of the inflammation upon the constitution run through 
all the stages with more rapidity than when it happens in 
other parts ; so that at its very beginning, it has the same 
effect upon the constitution which is only produced by the 
second stage of inflammation in other parts."* 

3. The synochus Jbrtis state of fever is known by a full, 
qullk, and round pulse without tension. The autumnal 
bilious fever and colic, also the gout, often appear in this 
form. 

4. Th f e synocha, or the common inflammatory state of fe- 
ver, attacks suddenly with chills, and is succeeded by a 
quick, frequent, and tense pulse, great heat, thirst, and 
pains in the bones, joints, breasts, or sides. These symp- 
toms sometimes occur in the plague, the jail and yellow fever, 
and the small-pox ; but they are the more common charac- 
teristics of pleurisy, gout, and rheumatism. They now 
and then occur in the influenza, the measles, and the puer- 
perile fever. 

5. There is a state of fever in which the pulse is small, 
but tense and quick. The patient, in this state of fever, is 
seldom confined to his bed. We observe it sometimes in 
the chronic rheumatism, and in pulmonary consumption. 
The inflammatory state of this grade of fever is proved from 
the ineflicacy of the volatile tinctur^of guaiacum and other 
stimulants to remove it, and from its yielding so suddenly 
to blood-letting. I have called it the synochula state of 
fever. 

* Treatise on Inflammation, chap. I. 8. 



PHENOMENA OF FEVER.* 27 

6. There is a state of fever inclining more to the synocha, 
than what is called the typhus, or low chronic state of fever. 
I have called it the synochoid state of fever. 

7. The synochus mitis, or mild bilious, and intermitting 
states of fever. 

8. The typhus state of fever is generally preceded by all 
those circumstances which debilitate the system, both by 
the action and abstraction of stimuli. It is known by a 
weak and frequent pulbe, a disposition to sleep, a torpor of 
the alimentary canal, tremors of the hands, a dry tongue, 
and, in some instances, by a diarrhoea. These symptoms 
occur most frequently in what is called the jail, the ship, 
and the hospital fever. I heard of it in a few cases in the 
yellow fever of 1793, and all writers take notice of cases of 
the plague, which run on into a slow fever that continues 
30 or 40 days. I have seen it succeed the common bilious 
fever, pleurisy, and influenza. It has been confounded with 
the malignant state of fever, or what is called the typhus 
gravior ; but it differs widely from it in being accompanied 
for the most part by a feeble excitement in the blood-vessels 
frofn a feeble stimulus, and by the usual signs of debility 
from abstraction in every other part of the body. 

From the accession of new stimuli, or an increase in the 
force of former ones, this typhus state of fever sometimes 
assumes, on the 1 1th, 14th, and even 20th days, the symp- 
toms of the synocha state of fever. It will be useful to re- 
member this remark, not only because it establishes the 
unity of fever, but because it will justify the use of a re- 
medy, seldom prescribed after the disease has acquired that 
name which associates it with stimulating medicines. 

The common name of this state of fever, is the nervous 
fever. This name is improper ; for it invades the nervous 
system by pain, delirium, and convulsions much less than 
several other states of fever. To prevent the absurd and 
often fatal association of ideas upon the treatment of this 
state of fever, I have called it, from its duration, the low 
chronic state of fever. I have adopted the term low, from 
Dr. Butter's account of the remitting fever of children, in 
order to distinguish it from states of fever to be mentioned 
hereafter, in which the patient is not confined to his bed. 
This new name of the typhus or nervous fever establishes 
its analogy with several other diseases. We have the acute 



28 • OUTLINES OF THE 

and the chronic rheumatism ; the acute and chronic pneu- 
mony, commonly called the pleurisy and pulmonary con- 
sumption ; the acute and chronic inflammation of the brain, 
known unfortunately by the unrelated names of phrenitis, 
madness, and internal dropsy of the brain. Why should 
we hesitate, in like manner, in admitting acute and chronic 
fever, in all those cases where no local inflammation 
attends ? 

9. The typhoid state of fever is composed of the syno. 
cha and low chronic states of fever. It is the slow nervous 
fever of Dr. Butter. The excitement of the blood-vessels 
is somewhat greater than in the low chronic state of fever. 
Perhaps the muscular fibres of the blood-vessels, in this 
state of fever, are affected by different degrees of stimulus 
and excitement. Supposing a pulse to consist of eight 
cords, I think I have frequently felt more or less of them 
tense or relaxed, according as the fever partook more or 
less of the synocha, or low chronic states of fever. This 
state of fever occurs most frequently in what are called the 
hectic and puerperal fevers, and in the scarletina. 

10. The hectic state of fever differs from all the other 
states of fever, by the want of regularity in its paroxysms, 
in which chills, fevers, and sweats are included ; and by 
the brain, nerves, muscles, and alimentary canal being but 
little impaired in their functions by it. It appears to be an 
exclusive disease of the blood-vessels. It occurs in the 
pulmonary consumption, in some cases of lues, of scro- 
phula, and of the gout, and after most of the states of fever 
which have been described. The force of the pulse is va- 
rious, being occasionally synochoid, typhoid, and typhus. 

11. Intermissions, or the intermitting and remitting 
states of fever, are common to all the states of fever which 
have been mentioned. But they occur most distinctly and 
universally in those which partake of the bilious diathesis. 
They have been ascribed to the reproduction of bile, to the 
recurrence of debility, and to the influence of the heavenly 
bodies upon the system. None of these hypotheses has 
explained the recurrence of fever, where the bile has not 
been in fault, where debility is uniform, and where the pa- ' 
roxysms of fever do not accord with the revolutions of any 
part of the solar system. I have endeavoured to account 
tor the recurrence of the paroxysm of fever, in common 



PHENOMENA OF FEVER. 29 

with all other periodical diseases, by means of a natural or 
adventitious association of motions. Dr. Percival has 
glanced at this law of animal matter ; and Dr. Darwin has 
explained by it, in the most ingenious manner, many natu- 
ral and morbid actions in the human body. 

12. There is a state of fever in which the morbid action 
of the blood-vessels is so feeble as scarcely to be percepti- 
ble. Like the hectic state of fever, it seldom affects the 
brain, nerves, muscles, or alimentary canal: It is known 
in the southern states of America by the name of imvard 
fevers. The English physicians formerly described it by 
the name of febricula. 

These twelve states of fever may be considered as prima- 
ry in their nature. All the states which remain to be enu- 
merated belong to some one of them, or they are com- 
pounds of two, three, or more of them. Even these pri- 
mary states of fever seldom appear in the simple form in 
which they have been described. They often blend their 
symptoms ; and sometimes all the states appear at different 
times in the course of a fever. This departure from a 
uniformity in the character of fevers must be sought for in 
the changes of the weather, in the casual application of fresh 
irritants, or in the operation of the remedies which have 
been employed to cure them. 

To the first class of the states of fever l^elong the sweat- 
ing, the fainting, the burning, and the cold and chilly states 
of fever. 

13. The sxveating state of fever occurs in the plague, in 
the yellow fever, in the small-pox, the pleurisy, the rheu- 
matism, and in the hectic and intermitting states of fever. 
Profuse sweats appeared every other day in the autumnal 
fever of 1795 in Philadelphia, without any other symptom 
of an intermittent. The English sweating sickness was 
nothing but a symptom of the plague. The sweats in all 
these cases are the effects of morbid and excessive action, 
concentrated in the capillary vessels. 

14. The fainting state of fever accompanies the plague, 
.the yellow fever, the small-pox, and some states of pleuri- 
sy. It is the effect of great depression ; hence it occurs 
most frequently in the beginning of those states of fever. 

15. The burning state of fever has given rise to what 
has been called a species of fever. It is the causus of au- 



50 OUTLINES OF THE 

thors. Dr. Mosely, who rejects the epithet of yellow, when 
applied to the bilious fever, because it is only one of its 
accidental symptoms, very improperly distinguishes the 
same fever by another symptom, viz. the burning heat of 
the skin, and which is not more universal than the yellow- 
ness which attends it. 

16. The cold and chilly state of fever diners from a com- 
mon chilly fit, by continuing four or five days, and to such 
a degree, that the patient frequently cannot bear his arms 
out of the bed. The coldness is most obstinate in the 
hands and feet. A coolness only of the skin attends in some 
cases, which is frequently mistaken for an absence of fever. 

In mentioning those states oi fever which affect the arte- 
rial system without any, or with but little local disease, I 
wish to be understood that they do not affect that system 
only. On the contrary, they bring the nerves, muscles, 
lymphatics, and brain more or less into sympathy with it. 
The last suffers most from those fevers which are derived 
from miasmata, and contagions, in consequence of their 
passing directly in most cases, from the nose to the brain. 
I proceed next to enumerate those states of fever which be- 
long to the 

II. Class of the order that was mentioned, in which there 
are local affections combined with general fever. They are, 

17. The intestinal state of fever. I have been anticipat- 
ed in giving this epithet to fever, by Dr. Balfour.* It in- 
cludes the cholera morbus, diarrhoea, dysentery, and colic. 
The remitting bilious fever appears, in all the above forms, 
in the summer months. They all belong to the febris in- 
tra versa of Dr. Sydenham. The jail fever appears likewise 
frequently in the form of diarrhoea and dysentery. The 
dysentery is the offspring of marsh and human miasmata, 
but it is often induced in a weak state of the bowels, by 
other exciting causes. The colic occasionally occurs with 
states of fever to be mentioned hereafter. 

18. The pulmonary state of fever includes the true and 
bastard pneumony in their acute forms ; also catarrh from 
cold and influenza, and the chronic form of pneumony in 
what is called pulmonary consumption. 

19. The eruptive state of fever includes the small-pox, 

* Account of the Intestinal Remitting Fever of Bengal. 



PHENOMENA OF FEVER. 31 

measles, erysipelas, military fever, chicken-pox, and pem- 
phigus. 

20. The anginose state of fever includes all those affec- 
tions of the throat which are known by the names of cy- 
nanche inflammatoria, tonsillaris, parotidea, maligna, scar- 
latina, and trachealis. The cynanche trachealis is a febrile 
disease. The membrane which produces suffocation and 
death in the wind-pipe is the effect of inflammation. Itjs 
said to be formed, like other membranes which succeed 
inflammation, from the coagulable lymph of the blood. 

21. The rheumatic state of fever is confined chiefly to 
the labouring part of mankind. The topical affection is 
seated most commonly in the joints and muscles, which, 
from being exercised more than other parts of the body, 
become more debilitated, and are, in consequence thereof, 
excited into morbid and inflammatory action. 

22. The arthritic or gouty state of fever differs from the 
rheumatic, in affecting, with the joints and muscles, all the 
nervous and lymphatic systems, the viscera, and the skin. 
Its predisposing, exciting, and proximate causes are the 
same as the rheumatic and other states of fever. It bears 
the same ratio to rheumatism, which the yellow fever bears 
to the common bilious fever. It is a fever of more force 
than rheumatism. 

23. The cephalic, in which are included the phrenitic, 
lethargic, apoplectic, paralytic, hydrocephalic, and maniacal 
states of fever. That madness is originally a state of 
fever, I infer, 1. From its causes, many of which are the 
same as those which induce all the other states of fever. 2.# 
From its symptoms, particularly a full, tense, quick, and 
sometimes a slow pulse. 3. From the inflammatory appear- 
ances of the blood which has been drawn to relieve it. 
And, 4. From the phenomena exhibited by dissection in 
the brains of maniacs, being the same as are exhibited by 
other inflamed viscera after death. These are, effusions of 
water or blood, abscesses, and schirrus. The"hardness in 
the brains of maniacs, taken notice of by several authors, 
is nothing but a schirrus (sui generis), induced by the ne- 
glect of sufficient evacuations in this state of fever. The 
reader will, perceive by these observations, that I reject 

^madness from its supposed primary seat A the mind or 
nervous. It is as much an original disease of the blood- 



32 OUTLINES OF THE 

vessels, as any other state of fever. It is to phrenkis, what 
pulmonary consumption is to pneumony. The derange- 
ment in the operations of the mind is the effect only ot a 
chronic inflammation of the brain, existing without an 
abstraction of muscular excitement. 

24. The nephritic state of fever, is often induced by 
calculi, but it frequently occurs in the gout, small-pox, and 
malignant states of fever. There is such an engorgement, 
or choaking of the vessels of the kidneys, that the secre- 
tion of the urine is sometimes totally obstructed, so that 
the bladder yields no water to the catheter. It is generally 
accompanied with a full or tense pulse, great pain, sickness, 
or vomiting, high coloured urine, and a pain along the 
thigh and leg, with occasionally a retraction of one of the 
testicles. It exists sometimes without any pain. Of this 
I met with several instances in the yellow fever of 1793. 
I include diabetes in this state of fever. 

25. The hydropic state of fever, in which are included 
collections of water, in the lungs, cavity of the thorax, 
cavity of the abdomen, ovaria, scrotum, testicles, and lower 
extremities, and usually preceded, and generally accompa- 
nied with morbid action in the blood-vessels. That dropsy 
is a state of fever, I have endeavoured to prove in another 
place.* Nineteen dropsies out of twenty appear to be 
original arterial diseases, and the water, which has been sup- 
posed to be their cause, is as much the effect of preternatural 
and morbid action in the blood-vessels, as pus, gangrene, 
and schirrus are of previous inflammation. This has been de- 

#monstrated, by the late Dr. Cooper, in a man who died of 
an ascites in the Pennsylvania hospital. Pus and blood, 
as well as water, were found in the cavity of the abdomen. 
It is no objection to this theory of dropsy, that we some- 
times find water in the cavities of the body after death, 
without any marks of inflammation in the contiguous blood- 
vessels. We often find pus, both in the living and dead 
body, under the same circumstances, where we are sure it 
was not preceded by any of the obvious marks of inflam- 
mation. 

26. The hemorrhagic state of fever, in which are includ- 
ed discharges of blood from the nose, lungs, stomach, 
liver, bowels, kidneys and bladder, haemorrhoidal vessels^ 
* On Dropsies, vol. II. 



PHENOMENA OF FEVER. 33 

and skill. Haemorrhages have been divided into active 
and passive. It would be more proper to divide them, 
like other states of general fever, into haemorrhages of 
strong and feeble morbid action. There is seldom an 
issue of blood from a vessel in which there does not exist 
preternatural or accumulated excitement. We observe 
this haemorrhagic state of fever most frequently in malig- 
nant fevers, in pulmonary consumption, in pregnancy, and 
in that period of life in which the menses cease to be re- 
gular. 

27. The amenorrhagic state of fever occurs more fre- 
quently than is suspected by physicians. A full and quick 
pulse, head-ach, thirst, and preternatural heat often accom- 
pany a chronic obstruction of the menses. The inefficac)'', 
and even hurtful effects, of what are called emenagogue 
medicines, in this state of the system, without previous 
depletion, show the propriety of introducing it among the 
different states of fever. 

I have designedly omitted to take notice of other states 
of general fever accompanied with local disease, because 
they are most frequently combined with some one or more 
of those which have been mentioned. They may all be 
seen in Dr. Cullen's Synopsis, with their supposed respec- 
tive generic characters, under the class of pyrexiae, and the 
order of fevers. We come now in the 

III. And last place, to mention the misplaced states of 
fever. The term is not a new one in medicine. The gout 
is said to be misplaced, when it passes from the feet to the 
viscera. The periodical pains in the head, eyes, ears, jaws, 
hips, and back, which occur in the sickly autumnal 
months, and which impart no fulness, force, nor frequency 
to the pulse, are all misplaced fevers. There are, besides 
these, many other local morbid affections, which are less 
suspected of belonging to febrile diseases. The nature of 
these states of fever may be understood, by recollecting 
one of the laws of sensation, that is, that certain impres- 
sions, which excite neither sensation nor motion in the part 
of the body to which they are applied, excite both in ano- 
ther part. Thus worms, which are not felt in the stomach 
or bowels, often produce a troublesome sensation in the 
throat ; and a stone, which is attended with no pain in the 
bladder, produces a troublesome itching in the glans penis. 

VOL. III. F. 



34 OUTLINES OF THE 

In like manner, the irritants which produce fever in ordi- 
nary cases pass through the blood-vessels, and convey their 
usual morbid effects into a remote part of the body which 
has been prepared to receive them by previous debility. 
That this is the case, I infer further, from fevers being 
called back from their misplaced or suftocated situations, 
by creating an artificial debility in the arteries by the ab- 
straction of blood. This is often done. in muscular con- 
vulsions, and in several diseases of the brain. 
Under this class of fevers are included 

28. The chronic hepatic state of fever. The causes, 
symptoms, and remedies of the liver disease of the East- 
Indies, as mentioned by Dr. Girdlestone, all prove that it 
is nothing but a bilious fever translated from the blood-ves- 
sels, and absorbed, or suffocated, as it were, in the liver. 
This view of the chronic hepatitis is important, inasmuch 
as it leads to the liberal use of all the remedies which cure 
bilious fever. Gall stones and contusions now and then 
produce a hepatitis, but under no other circumstances do 
I believe it ever exists, but as a symptom of general or 
latent fever. 

29. The hcemorrhoids are frequently a local disease, but 
they are sometimes accompanied with pain, giddiness, 
chills, and an active pulse. When these symptoms occur, 
it should be considered as a hemorrhoidal state of fever. 

30. The opthalmia, when it occurs, as it frequently does 
in sickly seasons, with a quick and tense pulse, and pains 
diffused over the whole head, may properly be called an 
opt halm ic state of fever. 

31. The tooth-aeh, and 

32. Ear-ach, when they arise from colds, and are attend- 
ed with great heat, a quick and tense pulse, and pains in 
the head, are odontalgic and otalgic states of fever. 

33. The apthae, from the pain and fever which attend 
them, are justly entitled to the name of the apthous state of 
fever. 

34. The symptoms of scrophula, as described by Dr. 
Handy, in his treatise on the glandular disease of Barba- 
does, clearly prove it to be a misplaced state of fever. 

35. The scurvy has lately been proved by Dr. Claiborne, 
in his inaugural dissertation, published in the year 1797' 
to arise from so many of the causes, arid to possess so 



PHENOMENA OF FEVER. 35 

many of the symptoms, of the low chronic and petechial 
states of fever, that I see no impropriety in considering it 
as a state of fever. 

36. The convulsive or spasmodic state of fever. Con- 
vulsions, it is vveii known, often usher in fevers, more es- 
pecially in children. But the connexion between spasmo- 
dic affections and fever, in adults, has been less attended to 
by physicians. The same causes which produced general 
fever and hepatitis in the East-Indies, in some soldiers, 
produced locked jaw in others. Several of the symptoms 
of this disease, as described by Dr. Girdlestone, such as 
coldness on the surface of the body, cold sweats on the 
hands and feet, intense thirst, a white tongue, incessant vo- 
mittings, and carbuncles, all belong to the malignant state 
of fever. * By means of blood-letting, and the other reme- 
dies for the violent state of bilious fever, I have seen the 
convulsions in this disease translated from the muscles to 
the blood-vessels, where they immediately produced all the 
common symptoms of fever. 

37. The hysterical and hypochondriacal states of fever. 
The former is known by a rising in the throat, which is for 
the most part erroneously ascribed to worms, by pale urine, 
and by a disposition to shed tears, or to laugh upon trifling 
occasions. The latter discovers itself by false opinions of 
the nature and danger of the disease under which the patient 
labours. Both these states of the nervous system occur 
frequently in the gout and in the malignant state of fever. 
It is common to say, in such cases, that patients have a 
complication of diseases ; but this is not true, for the hy- 
sterical and hypochondriacal symptoms are nothing but the 
effects of one remote cause, concentrating its force chiefly 
upon the nerves and muscles. 

38. The cutaneous state of fever. Dr. Sydenham calls 
a dysentery a " febris introversa." — Eruptions of the skin 
are often nothing but the reverse of this introverted fever. 
They are a fever translated to the skin ; hence we find them 
most common in those countries and seasons in which fe- 
vers are epidemic. The prickly heat, the rash, and the 
essere of authors, are all states of misplaced fever. " Agues, 
fevers, and even pleurisies (says Mr. Townsend, in his 
Journey through Spain, f) are said often to terminate in 

* Essay on the Spasmodic Affections in India, p. 53, 54, 55. 
t Vol. II. Dublin edition, p. 262. 



36 OUTLINES, SCC. 

scabies, and this frequently gives place to them, returning, 
however, when the fever ceases. In adults it takes posses- 
sion of the hands and arms, with the legs and thighs, co- 
vering them with a filthy crust." Small biles are common 
among the children in Philadelphia, at the time the cholera 
infantum makes its appearance. These children always 
escape the summer epidemic. The elephantiasis described 
by Dr. Hillary, in his account of the diseases of Barbadoes, 
is evidently a translation of an intermittent to one of the 
limbs. It is remarkable, that the leprosy and malignant 
fevers of all kinds have appeared and declined together in 
the same ages and countries. But further, petechiae some- 
times appear on the skin without fever. Cases of this kind, 
with, and without haemorrhages, are taken notice of by 
Riverius,* Dr. Duncan, and many other practical writers. 
They are cotemporary or subsequent to fevers of a malig- 
nant complexion. They occur likewise in the scurvy. 
From some of the predisposing, remote, and exciting causes 
of this disease, and from its symptoms and remedies, I 
have suspected it, like the petechiae mentioned by Riverius, 
to be originally a fever generated by human miasmata, in 
a misplaced state. The haemorrhages which sometimes 
accompany the scurvy, certainly arise from a morbid state 
of the blood-vessels. The heat and quick pulse of fever 
are probably absent, only because the preternatural excite- 
ment of the whole sanguiferous system is confined to those 
extreme or cutaneous vessels which pour forth blood. In 
like manner the fever of the small-pox deserts the blood- 
vessels, as soon as a new action begins on the skin. Or 
perhaps the excitability of the larger blood-vessels may be 
so far exhausted by the long or forcible impression of the 
remote and predisposing causes of the scurvy, as to be in- 
capable of undergoing the convulsive action of general 
fever. 

With this I close the history of the phenomina of fever. 
It is imperfect from its brevity, as well as from other causes- 
I commit it to my pupils to be corrected and improved. 

*' We think our fathers fools, so wise we ctow 
" Our wiser sons, / /wfie, will think us so/' ' 

• Praxis Medica, lib. xviii. cap.i 



AN ACCOUNT 



OF THE 



BILIOUS REMITTING YELLOW FEVER 



AS IT 



APPEARED IN PHILADELPHIA, 

IN THE YEAR 17«tt 



AN ACCOUNT, &c. 



BEFORE I proceed to deliver the history of this fc 
ver, it will be proper to give a short account of the diseases 
•which preceded it. 

The state of the weather during the first seven months of 
the year, and during the time in which the fever prevailed 
in the city, as recorded by Mr Rittenhouse, will be insert- 
ed immediately after the history of the disease. 

The mumps, which made their appearance in December, 
.1792, continued to prevail during the month of January, 
1793. Besides this disease, there were many cases of ca- 
tarrh in the city, brought on chiefly by the inhabitants ex- 
posing themselves for several hours on the damp ground, 
in viewing the aerial voyage of Mr. Blanchard, on the 9th 
day of the month. 

The weather, which had been moderate in December 
and January, became cold in February. The mumps con- 
tinued to prevail during this month with symptoms so in- 
flammatory as to require, in some cases, two bleedings. 
Many people complained this month of pains and swellings 
in the jaws. A ihw had the scarlatina anginosa. 

The mumps, pains in the jaws, and scarlatina continued 
throughout the month of March. I was called to two cases 
of pleurisy in this month, which terminated in a temporary 
mania. One of them was a woman of ninety years of age, 
who recovered. The blood drawn in the other case (a gen- 
tleman from Maryland) was dissolved. The continuance 
of a tense pulse induced me, notwithstanding, to repeat the 
bleeding. The blood was now sizy. A third bleeding 
was prescribed, and my patient recovered. Several cases 
o( obstinate erysipelas succeeded inoculation in children 
during this and the next month, one of which proved fatal. 

Blossoms were universal on the fruit-trees, in the gardens 
of Philadelphia, on the first day of April. The scarlatina 



4U AN ACCOUNT OF THE 

anginosa continued to be the reigning epidemic in thfe 

""There were several warm days in May, but the city was 
in general healthy. The birds appeared two weeks sooner 
this sprinsr than usual. , . 

The relister of the weather shows, that there were many 
warm days in June. The scarlatina continued to maintain 
its empire during this month. 

The weather was uniformly warm in July. 1 he scarla- 
tina continued during the beginning of this month, with 
symptoms of great violence. A son of James Sharsw-ood, 
aged seven years, had, with the common symptoms of this 
disease, great pains and swellings in his limbs, accompani- 
ed with a tense pulse. I attempted in vain to relieve him 
by vomits and purges. On the 10th day of the month, I 
ordered six ounces of blood to be drawn from his arm, 
which I observed afterwards to be very sizy. The next 
day he was nearly well. Between the 22d and the 24th 
days of the month, there died three persons, whose respec- 
tive ages were 80, 92, and 96 \ The weather at this time 
was extremely warm. I have elsewhere taken notice of the 
fatal influence" of extreme heat, as well as cold, upon human 
life in old people. A few bilious remitting fevers appeared 
towards the close of this month. One of them under my 
care ended in a typhus or chronic fever, from which the 
patient was recovered with great difficulty. It was the son 
of Dr. Hutchins, of the island of Barbadoes. 

The weather, for the first two or three weeks in August, 
was temperate and pleasant. The cholera morbus and re- 
mitting fevers were now common. The latter were attend- 
ed with some inflammatory action in the pulse, and a de- 
termination to the breast. Several dysenteries appeared at 
this time, both in the city and in its neighbourhood. Dur- 
ing the later part of July, and the beginning of this month 
a number of the distressed inhabitants of St. Domingo who 
had escaped the desolation of fire and sword, arrived in the 
city. Soon after their arrival, the influenza made its ap- 
pearance, and spread rapidly among our citizens. The 
scarlatina still kept up a feeble existence among children. 
The above diseases were universal, but they were not at- 
tended with much mortality. They prevailed in different 
parts of the city, and each appeared occasionally to be the 



BILIOUS YELLOW FEVER OF 1793. 41 

ruling epidemic. The weather continued to be warm and 
dry. There was a heavy rain on the twenty-fifth of the 
month, which was remembered by the citizens of Phila- 
delphia, as the last that fell for many weeks afterwards. 

There was something in the heat and drought of the 
summer months which was uncommon, in their influence 
upon the human body. Labourers every where gave out 
(to use the country phrase) in harvest, and frequently too 
when the mercury in Fahrenheit's thermometer was under 
84°. It was ascribed by the country people to the calm- 
ness of the weather, which left the sweat produced by heat 
and labour to dry slowly upon the body. 

The crops of grain and grass were impaired by the 
drought. The summer fruits were as plentiful as usual, 
particularly the melons, which were of an excellent quality. 
The influence of the weather upon the autumnal fruits, and 
upon vegitation in general shall be mentioned hereafter. 

I now enter upon a detail of some solitary cases of the 
epidemic, which soon afterwards spread distress through 
our city, and terror throughout the United States. 

On the 5th of August, I was requested by Dr. Hodge 
to visit his child. I found it ill with a fever of a bilious 
kind, which terminated (with a yellow skin) in death on 
the 7th of the same month. 

On the 6th of August, I was called to Mrs. Bradford, 
the wife of Mr. Thomas Bradford. She had all the symp- 
toms of a bilious remittent, but they were so acute as to 
require two bleedings, and several successive doses of phy- 
sic. The last purge she took was a dose of calomel, which 
operated plentifully. For several days after her recovery, 
her eyes and face were of a yellow colour. 

On the same day, I was called to the son of Mrs. M'Nair, 
who had been seized violently with all the usual symptoms 
of a bilious fever. I purged him plentifully with salts and 
creamor tartar, and took ten or twelve ounces of blood from 
his arm. His symptoms appeared to yield to these reme- 
dies ; but on the 10th of the month a haemorrhage from the 
nose came on, and on the morning of the 12th he died. 

On the 7th of this month I was called to visit Richard 
Palmer, a son of Mrs. Palmer, in Chesnut-street. He had 
been indisposed for several days with a sick stomach, and 
vomiting after eating. He now complained of a fever and 

VOL. IT I. F 



42 AN ACCOUNT OF THE 

head-ach. I gave him the usual remedies for the bilious 
fever, and he recovered in a few days. On the 15th i day 
of the same month I was sent for to visit his brother W ll- 
liam, who was seized with all the symptoms of the same 
disease. On the 5th day his head-ach became extremely 
acute, and his pulse fell to sixty strokes in a minute, 
suspected congestion to have taken place in his brain, and 
ordered him to lose eight ounces of blood. His pulse be- 
came more frequent, and less tense after bleeding, and he 
recovered a day or two afterwards. 

On the 14th day of this month I was sent for to visit 
Mrs. Learning, the wife of Mr. Thomas Learning. I sus- 
pected at first that she had the influenza, but in a day or two 
her fever put on bilious symptoms. She was affected with 
an uncommon disposition to faint. Her pulse was languid, 
but tense. I took a few ounces of blood from her, and 
purged her with salts and calomel. I afterwards gave her 
a small dose of laudanum which disagreed with her. In 
my note book I find I have recorded that " she was worse 
for it." I was led to make this remark by its being so very 
uncommon for a person, who had been properly bled and 
purged, to take laudanum in a common bilious fever with- 
out being benefited by it. She recovered, however, slowly, 
and was yellow for many days afterwards. 

On the morning of the 18th of this month I was request- 
ed to visit Peter Aston, in Vine-street, in consultation with 
Dr. Say. I found him on the third day of a most acute 
bilious fever. His eyes were inflamed, and his face flushed 
with a deep red colour. His pulse seemed to forbid eva- 
cuations. We prescribed the strongest cordials, but to no 
purpose. We found him, at 6 o'clock in the evening, 
sitting upon the side of his bed, perfectly sensible, but 
without a pulse, with cold clammy hands, and his face of a 
yellowish colour. He died a few hours after we left him. 

None of the cases which I have mentioned excited the 
least apprehension of the existenee of a malignant or yellow 
fever in our city ; for I had frequently seen sporadic cases 
in which the common bilious fever of Philadelphia had put 
on symptoms of great malignity, and terminated finally in 
a few dc.ys, and now and then with a yellow colour on the 
skin, before or immediately after death. 

On the 19th of this month I was requested to visit the 



BILIOUS YELLOW FEVER OF 1793. 43 

wife of Mr. Peter Le Maigre, in Water-street, between 
Arch and Race- streets, in consultation with Dr. Fouike 
and Dr. Hodge. I found her in the last stage of a highly 
bilious fever. She vomited constantly, and complained 
of great heat and burning in her stomach. The most pow- 
erful cordials and tonics were prescribed, but to no pur- 
pose. She died on the evening of the next day. 

Upon coming out of Mrs. Le Maigre's room I remark- 
ed to Dr. Fouike and Dr. Hodge, that I had seen an un- 
usual number of bilious fevers, accompanied with symp- 
toms of uncommon malignity, and that I suspected all was 
not right in our city. Dr. Hodge immediately replied, 
that a fever of a most malignant kind had carried off four 
or five persons within sight of Mr. Le Maigre's door, and 
that one of them had died in twelve hours after the attack 
ef the disease. This information satisfied me that my ap- 
prehensions were well founded. The origin of this fever 
was discovered to me at the same time, from the account 
which Dr Fouike gave me of a quantity of damaged coffee 
which had been thrown upon Mr. Ball's wharf, and in the 
adjoining dock, on the 24th of July, nearly in a line with 
Mr. Le Maigre's house, and which had putrefied there to 
the great annoyance of the whole neigbourhood. 

After this consultation I was soon able to trace all the 
cases of fever which I have mentioned to this course. Dr. 
Hodge lived a few doors above Mr. Le Maigre's where his 
child had been exposed to the exhalation from the coffee 
for several days. Mrs. Bradford had spent an afternoon 
in a house directly opposite to the wharf and dock on 
which the putrid coffee had emitted its noxious effluvia, a 
few days before her sickness, and had been much incom- 
moded by it. Her sister, Mrs. Learning, had visited her 
during her illness at her house, which was about two hun- 
dred yards from the infected wharf. Young Mr. M'Nair 
and Mrs. Palmer's two sons had spent whole days in a 
compting house near where the coffee was exposed, and 
each of theni had complained of having been made sick by- 
its offensive smell, and Mr. Aston had frequently been in 
Water-street near the source of the exhalation. 

This discovery of the malignity, extent, and origin of a 
fever which I knew to be attended with great danger and 
mortality, gave me great pain. I did not hesitate to name 



44 AN ACCOUNT OF THE 

I had once seen it 



it the bilious remitting yellow fever. I had once seen it 
epidemic in Philadelphia, in the year 1762. Its symptoms 
were among the first impressions which diseases made 
upon my mind. I had recorded some of these symptoms, 
as well as its mortality. I shall here introduce a short ac- 
count of it, from a note book which I kept during my ap- 
prenticeship. 

" In the year 1762, in the months of August, Septem- 
ber, October, November, and December, the bilious yel- 
low' fever prevailed in Philadelphia, after a very hot summer, 
and spread like a plague, carrying off daily, for some time, 
upwards of twenty persons. 

" The patients were generally seized with rigours, which 
were succeeded with a violent fever, and pains in the head 
and back. The pulse was full, and sometimes irregular. 
The eyes were inflamed, and had a yellowish cast, and a 
vomiting almost always attended. 

" The 3d, 5th, and 7th days were mostly critical, and 
the disease generally terminated on one of them, in life or 
death. 

" An eruption on the 3d or 7th day over the body prov- 
ed salutary. 

" An excessive heat and burning about the region of 
the liver, with cold extremities, portended death to be at 
hand." 

I have taken notice, in my note book, of the principal 
remedy which was prescribed in this fever by my preceptor 
in medicine, but this shall be mentioned hereafter. 

Upon my leaving Mrs. Le Maigre's, I expressed my 
distress at what I had discovered, to several of my fellow- 
citizens. The report of a malignant and mortal fever be- 
ing in town spread in every direction, but it did not gain 
universal credit. Some of those physicians who had' not 
seen patients in it denied that any such fever existed, and 
asserted (though its mortality was not denied) that it was 
nothing but the common annual remittent of the city. 
Many of the citizens joined the physicians in endeavouring 
to discredit the account I had given of this fever, and for 
a while it was treated with ridicule or contempt. Indigna- 
tion in some instances was excited against me, and one of 
my friends, whom I advised in this early stage of the dis- 
ease to leave the city, has since told me that for that advice 
" he had hated me." 



BILIOUS YELLOW FEVER OF 1793. 45 

My lot in having thus disturbed the repose of the public 
mind, upon the subject of general health, was not a singu- 
lar one. There are many instances upon record, of phy- 
sicians who have rendered themselves unpopular, and even 
odious to their fellow-citizens, by giving the first notice of 
the existence of malignant and mortal diseases. A physi- 
cian who asserted that the plague was in Messina, in the 
year 1743, excited so much rage in the minds of his fel- 
low-citizens against him, as to render it necessary for him 
to save his life by retreating to one of the churches of that 
city. 

In spite, however, of all opposition, the report of the 
existence of a malignant fever in the city gained so much 
ground, that the governor of the state directed Dr. Hut- 
chinson, the inspector of sickly vessels, to inquire into the 
truth of it, and into the nature of the disease. 

In consequence of this order, the doctor wrote letters to 
several of the physicians in the city, requesting information 
relative to the fever. To his letter to me, dated the 24th 
of August, I replied on the same day, and mentioned not 
only the existence of a malignant fever, but the streets it 
occupied, and my belief of its being derived from a quan- 
tity of coffee which had putrefied on a wharf near Arch- 
street. This, and other information collected by the doc- 
tor, was communicated to the health officer, in a letter 
dated the 27th of August, in which he mentioned the parts 
of the city where the disease prevailed, and the number of 
persons who had died of it, supposed by him to be about 
40, but which subsequent inquiries proved to be more 
than 150. He mentioned further, in addition to the da- 
maged coffee, some putrid hides, and other putred animal 
and vegetable substances, as the supposed cause of the 
fever, and concluded by saying, as he had not heard of any 
foreigners or sailors being infected, nor of its being found 
in any lodging-houses, that " it was not an imported dis- 
ease." 

In the mean while the disease continued to spread, and 
with a degree of mortality that had never been known from 
common fevers. 

On the 25th of the month, the college of physicians was 
summoned by their president to meet, in order to consult 
about the best methods of checking the progress of the 



46 AN ACCOUNT OF THE 

fever in the city. After some consideration upon the 
nature of the disease, a committee was appointed to draw 
up some directions for those purposes ; and the next day 
the following were presented to the college, and adopted 
unanimously by them. They were afterwards published 
in most of the newspapers. 

Philadelphia, August 26th, 1793. 

The college of physicians having taken into considera- 
tion the malignant and contagious fever that novy prevails 
in this city, have agreed to recommend to their fellow- 
citizens the following means of preventing its progress. 

1st. That all unnecessary intercourse should be avoided 
with such persons as are infected by it. 

2d. To place a mark upon the door or window of such 
houses as have any infected persons in it. 

3d. To place the persons infected in the centre of large 
and airy rooms, in beds without curtains, and to pay the 
strictest regard to cleanliness, by frequently changing their 
body and bed linen, also by removing, as speedily as pos- 
sible, all offensive matters from their rooms. 

4th. To provide a large and airy hospital, in the neigh- 
bourhood of the city, for the reception of such poor per- 
sons as cannot be accompanied with the above advantages 
in private houses. 

5th. To put a stop to the tolling of the bells. 

6th. To bury such persons as die of this fever in car- 
riages, and in as private a manner as possible. 

7th. To keep the streets and wharves of the city as 
tlean as possible. As the contagion of the disease may be 
taken into the body, and pass out of it without producing 
the fever, unless it be rendered active by some occasional 
cause, the following means should be attended to, to pre- 
vent the contagion being excited into action in the body. 

8th. To avoid all fatigue of body and mind. 

9th. To avoid standing or sitting in the sun ; also in a 
current of air, or in the evening air. 

10th. To accommodate the dress to the weather, and to 
exceed rather in warm, than in cool clothing. 

11th. To avoid intemperance, but to use fermented 
liquors, such as wine, beer, and cyder, in moderation. 

The college conceive fires to be very ineffectual, if not 



BILIOUS YELLOW FEVER OF 1793. 47 

dangerous means of checking the progress of this fever. 
They have reason to place more dependence upon the 
burning of gunpowder. The benefits of vinegar and cam- 
phor are confined chiefly to infected rooms, and they cannot 
be used too frequently upon handkerchiefs, or in smelling- 
bottles, by persons whose duty calls to visit or attend the 
sick. 

Signed by order of the college, 

WILLIAM SHIPPEN, jun. 

Vice president. 
SAMUEL P. GRIFFITTS, 

Secretary. 

From a conviction that the disease originated in the 
putrid exhalations from the damaged coffee, I published in 
the American Daily Advertiser, of August 29th, a short 
address to the citizens of Philadelphia, with a view of di- 
recting the public attention to the spot where the coffee lay, 
and thereby of checking the progress of the fever as far as 
it vvas continued by the original cause. 

This address had no other effect than to produce fresh 
clamours against the author ; for the citizens, as well as 
most of the physicians of Philadelphia, had adopted a tra- 
ditional opinion that the yellow fever could exist among us 
only by importation from the West- Indies. 

In consequence, however, of a letter, from Dr. Foulke 
to the mayor of the city, in which he had decided, in a 
positive manner, in favour of the generation of the fever 
from the putrid coffee, the mayor gave orders for the remo- 
val of the coffee, and the cleaning of the wharf and dock. 
It was said that measures were taken for this purpose ; but 
Dr. Foulke, who visited the place where the coffee la}-, 
repeatedly assured me, that they were so far from being 
effectual, that an offensive smell was exhaled from it many 
days afterwards. 

I shall pass over, for the present, the facts and argu- 
ments on which I ground my assertion of the generation 
of this fever in our city. They will come in more pro- 
jktIv in the close of the history of the disease. 

The seeds of the fever, when received into the body, 
were generally excited into action in a few days. I met 



48 AN ACCOUNT OF THE 

with several cases in which they acted so as to produce a 
fever on the same day in which they were received into the 
system, and I heard of two cases in which they excited 
sickness, fainting, and fever within one hour after the per- 
sons were exposed to them. I met with no instance in 
which there was a longer interval than sixteen days between 
their being received into the body and the production of 
the disease. 

This poison acted differently in different constitutions, 
according to previous habits, to the degrees of predispos- 
ing debility, or to the quantity and concentration of the 
miasmata which had been received into the body. 

In some constitutions, the miasmata were at once a re- 
mote, a predisposing, and an exciting cause of the disease ; 
hence some persons were affected by them, who had not 
departed in any instance from their ordinary habits of liv- 
ing, as to diet, dress, and exercise. But it was more fre- 
quently brought on by those causes acting in succession to 
each other. 

I shall here refer the reader to the principles laid down 
in the outlines of the phenomena of fever, for an account 
of the manner in which the system was predisposed to this 
disease, by the debility induced by the reduction of its ex- 
citement, by action and abstraction, and by subsequent 
depression. Where a predisposition was thus produced, 
the fever was excited by the following causes, acting di- 
rectly or indirectly upon the system. Where this predis- 
position did not exist, the exciting causes produced both 
the predisposition and the disease. They were, 

1. Great labour, or exercise of body or mind, in walk- 
ing, riding, watching, or the like. It was labour which 
excited the disease so universally among the lower class of 
people. A long walk often induced it. Few escaped it 
after a day, or even a few hours spent in gunning. A hard 
trotting horse brought it upon two of my patients. Perhaps 
riding on horseback, and in the sun, was the excitingcau.se 
of the disease in most of the citizens and strangers who 
were affected by it in their flight from the city. A fall 
excited it in a girl, and a stroke upon the head excited it 
m a young man who came under my care. Manv people 
were seized with the disease in consequence of their ex- 
ertions on the night of the 7th of September, in extiu. 



BILIOUS YELLOW FEVER OF 1793. 49 

guishing the fire which consumed Mr. Dobson's printing- 
office, and even the less violent exercise of working the 
fire engines, for the purpose of laying the dust in the 
streets, added frequently to the number of the sick. 

2. Heat, from every cause, but more especially the heat 
of the sun, was a very common exciting cause of the dis- 
ease. • The register of the weather during the latter end of 
August, the whole of September, and the first two weeks 
in October, will show how much the heat of the sun must 
have contributed to excite the disease, more especially 
among labouring people. The heat of common fires like- 
wise became a frequent cause of the activity of the miasma- 
ta where they had been received into the body ; hence the 
greater mortality of the disease among bakers, blacksmiths, 
and hatters than among any other class of people. 

3. Intemperance in eating or drinking. A plentiful 
meal, and a few extra glasses of wine seldom failed of ex- 
citing the fever. But where the body w r as strongly im- 
pregnated with the seeds of the disease, even the smallest 
deviation from the customary stimulus of diet, in respect 
to quality or quantity, roused them into action. A supper 
of twelve oysters in one, and of but three in another, of my 
patients produced the disease. Half an ounce of meat ex- 
cited it in a lady who had lived, by my advice, for two 
weeks upon milk and vegetables, and even a supper of sal- 
lad, dressed after the French fashion, excited it in one of 
Dr. Mease's patients. 

4. Fear. In many people the disease was excited by a 
sudden paroxysm of fear ; but I saw some remarkable in- 
stances where timid people escaped the disease, although 
they were constantly exposed to it. Perhaps a moderate 
degree of fear served to counteract the excessive stimulus 
of the miasmata, and thereby to preserve the body in a state 
of health)' equilibrium. I am certain that fear did no harm 
after the disease was formed, in those cases where great 
morbid excess of action had taken place. It was an early 
discovery of this tact which led me not to conceal from my 
patients the true name of this fever, whim I was called to them 
on the day of their being attacked by it. The fear co-operat- 
ed with some of my remedies (to be mentioned hereafter) 
in reducing the morbid excitement of the arterial system. 

5. Grief. It was remarkable that the disease wis not 



vol. in. c 



4 & 



50 AN ACCOUNT OF THE 

excited in many cases in the attendants upon the sick, 
while there was a hope of their recovery. The grief which 
followed the extinction of hope, by death, frequently pro- 
duced it within a day or two afterwards, and that not in 
one person only, but often in most of the near relations of 
the deceased. But the disease was also produced by a 
change in the state of the mind directly opposite to that 
which has been mentioned. Many persons that attended 
patients who recovered, were seized with the disease a day 
or two after they were relieved from the toils and anxiety 
of nursing. The collapse of the mind from the abstraction 
of the stimulus of hope and desire, by their ample gratifi- 
cation, probably produced that debility, and loss of the 
equilibrium in the system, which favoured the activity of 
the miasmata in the manner formerly mentioned.* 

The effects of both the states of mind which have been 
described, have been happily illustrated by two facts which 
are recorded by Dr. Jackson. f He tells us, that the garri- 
sons of Savannah and York-town were both healthy during 
the siege of diose towns, but that the former became sickly 
as soon as the French and American armies retreated from 
before it, and the latter, immediately after its capitulation. 

6. Cold. Its action, in exciting the disease, depended upon 
the diminution of the necessary and natural heat of the body, 
and thereby so far destroying the equilibrium of the system, 
as to enable the miasmata to produce excessive or convul- 
sive motions in the blood-vessels. The night air, even in 
the warm month of September, was often so cool as to excite 
the disease, where the dress and bed-clothes were not ac- 
commodated to it. It was excited in one case by a person's 
only wetting his feet, in the month of October, and neg- 
lecting afterwards to change his shoes and stockings. 
Every change in the weather, that was less than that which 
produces frost, evidently increased the number of sick peo- 
ple. This was obvious after the 18th and 19th of Septem- 
ber, when the mercury fell to 44° and 45°. The hopes of 
the city received a severe disappointment upon this occa- 
sion, tor I well recollect there was a general expectation 
that this change in the weather would have checked the 
disease. The same increase of the number of sick was 

.* Outlines of the phenomena of fever. 
t Treatise on the Fevers of Jamaica, p. 298. 



BILIOUS YELLOW FEVER OF 1793. 51 

observed to follow the cool weather which succeeded the 
6th and 7th of October, on which days the mercury fell to 
43° and 46°. 

It was observed that those persons who were habitually 
exposed to the cool air, were less liable to the disease than 
others. I ascribe it to the habitual impression of the cool 
night air upon the bodies of the city watchmen, that but 
four or five of them, out of twenty-five, were affected by 
the disease. 

After the body had been heated by violent exercise, a 
breeze of cool air sometimes excited the disease in those 
cases where there had been no change in the temperature 
of the weather. 

7. Sleep. A great proportion of all who were affected 
by this fever, were attacked in the night. Sleep induced 
what I have called debility from abstraction, and thereby 
disposed the miasmata which floated in the blood, to act 
with such force upon the system as to destroy its equilibri- 
um, and thus to excite a fever. The influence of sleep as 
a predisposing, and exciting cause was often assisted by 
the want of bed-clothes, suited to the midnight or morning 
coolness of the air. 

8. Immoderate evacuations. The efficacy of moderate 
purging and bleeding in preventing the disease, led some 
people to use those remedies in an excess, which both pre- 
disposed to the disease, and excited it. The morbid effects 
of these evacuations, were much aided by fear, for it was 
this passion which perverted the judgment in such a man- 
ner, as to lead to the excessive use of remedies, Which to 
be effectual, should only be used in moderate quantities. 

The disease appeared with different symptoms, and in 
different degrees, in different people. They both varied 
likewise with the weather. In describing the disease, I 
shall take notice of the changes in the symptoms, which 
were produced by changes in the temperature of the air. 

The precursors, or premonitory signs of this fever were, 
costiveness, a dull pain in the right side, defect of appetite, 
flatulency, perverted taste, heat in the stomach, giddiness, 
or pain in the head, a dull, watery, brilliant, yellow, or red 
eye, dim and imperfect vision, a hoarseness, or slight sore 
throat, low spirits, or unusual vivacity, a moisture on the 
hands, a disposition to sweat at nights, or after moderate 



52 AN ACCOUNT OF THE 

exercise, or a sudden suppression of night sweats, lhe 
dull eye and the lowness of spirits, appeared to be the ef- 
fects of such an excess in the stimulus of the miasmata 
as to induce depression, while the brilliant eye, and the unu- 
sual vivacity, seemed to have been produced by a less quanti- 
ty of the miasmata acting as a cordial upon the system. More 
or less of these symptoms, frequently continued for two or 
three days before the patients were confined to their beds, 
and in some people they continued during the whole time 
of its prevalence in the city, without producing the dis- 
ease. I wish these symptoms to be remembered by the 
reader. They will form the corner stone of a system 
which I hope will either eradicate the disease altogether, or 
render it as safe as an intermitting fever, or as the small- 
pox when it is received by inoculation. 

Frequent as these precursors of the fever were, they were 
not universal. Many went to bed in good health, and 
awoke in the night with a chilly fit. Many rose, in the morn- 
ing after regular and natural sleep, and were seized at their 
work, or after a walk, with a sudden and unexpected attack 
of the fever. In most of these cases the disease came on 
with a chilly fit, which afforded by its violence or duration a 
tolerable presage of the issue of the disease. 

Upon entering a sick room where a patient was confined 
by this fever, the first thing that struck the eye of a physi- 
cian was the countenance. It was as much unlike that 
which is exhibited in the common bilious fever, as the face 
of a wild, is unlike the face of a mild domestic animal. 
The eyes were sad, watery, and so inflamed, in some 
cases, as to resemble two balls of fire. Sometimes they 
had a most brilliant or ferocious appearance. The face 
was suffused with blood, or of a dusky colour, and the 
whole countenance was downcast and clouded. After the 
10th of September, when a determination of blood to the 
brain became universal, there was a preternatural dilatation 
of the pupil. Sighing attended in almost ever}- case. The 
skin was dry, and frequently of its natural temperature. 
These were the principal symptoms which discovered them* 
selves to the eye and hand of a physician. The answers to 
the first questions proposed upon visiting a patient, were 
calculated to produce a belief in the mind of a physician, 
that the disease under which the patient laboured was not 



BILIOUS YELLOW FEVER OF 1793. 53 

the prevailing malignant epidemic. I did not for many 
weeks meet with a dozen patients, who acknowledged that 
they had any other indisposition than a common cold, or a 
slight remitting or intermitting fever. I was particularly 
struck with this self-deception in many persons, who had 
nursed relations that had died with the yellow fever, and 
who had been exposed to it in neighbourhoods where it 
had prevailed for days and even weeks with great mortality. 
I shall hereafter trace a part of this disposition in the sick 
to deceive themselves to the influence of certain publica- 
tions, which appeared soon after the disease became epide- 
mic in the city. 

In the further history of this fever, I shall describe its 
symptoms as they appeared, 

I. In the sanguiferous system. 

II. In the liver, lungs, and brain. 

III. In the alimentary canal; in which I include the 
stomach as well as the bowels. 

IV. In the secretions and excretions. 

V. In the nervous system. 

VI. In the senses and appetites. 

VII. In the lymphatic and glandular system. 

VIII. Upon the skin. 

IX. In the blood. 

After having finished this detail, I shall mention some 
general characters of the disease, and afterwards subdivide 
it into classes, according to its degrees and duration. 

I. The blood-vessels were affected more or less in every 
ease of this fever. I have elsewhere said, that a fever is 
occasioned by a convulsion in the arterial system.* When 
the epidemic, which we are now considering, came on with 
a full, tense, and quick pulse, this convulsion was very 
perceptible ; but it frequently came on with a weak pulse, 
often without any preternatural frequency or quickness, 
and sometimes so low as not to be perceived without press- 
ing the artery at the wrists. In many cases the pulse inter- 
mitted after the fourth, in some after the fifth, and in others 
after the fourteenth stroke. These intermissions occurred 
in several persons who were infected, but who were not 
confined by the fever. They likewise continued in several 
of my patients for many days after their recovery. Thi^ 
* Outlines of the phenomena of fever. 



54 AN ACCOUNT OF THE 

was the case in particular in Mrs. Clymer, Mrs. Palmer's 
son William, and in a son of Mr. William Compton. In 
some, there was a preternatural slowness of the pulse. It 
beat 44 strokes in a minute in Mr. B. W. Morris, 48 m 
Mr. Thomas Warton, Jun. and 64 in Mr. William San- 
som, at a time when they were in the most imminent dan- 
ger. Dr. Physick informed me, that in one of his pa- 
tients the pulse was reduced in frequency to 30 strokes in 
a minute. All these different states of the pulse have been 
taken notice of by authors who have described pestilential 
fevers.* They have been improperly ascribed to the ab- 
sence of fever : I would rather suppose that they are oc- 
casioned by the stimulus of the remote cause acting upon 
the arteries with too much force to admit of their being 
excited into quick and convulsive motions. The remedy 
which removed it (to be mentioned hereafter) will render 
this explanation of its cause still more probable. Milton 
describes a darkness from an excess of light. In like 
manner we observe, in this small, intermitting, and slow 
pulse, a deficiency of strength from an excess of force ap- 
plied to it. In nearly every case of it which came under 
my notice, it was likewise tense or chorded. This species 
of pulse occurred chiefly in the month of August, and in 
the first ten days in September. I had met with it for- 
merly in a sporadic case of yellow fever. It was new to 
all my pupils. One of them, Mr. Washington, gave it 
the name of the " undescribable pulse." It aided in deter- 
mining the character of this fever before the common bili- 
ous remittent disappeared in the city. For awhile, I ascri- 
bed this peculiarity in the uilse, more especially its slow- 
ness, to an affection of the brain only, and suspected that 
it was produced by what I have taken the liberty elsewhere 
to call the phrenicula, or inflammatory state of the internal 
dropsy of the brain, and which I have remarked to be an 
occasional symptom and consequence of remitting fever, f 
I was the more disposed to adopt this opinion, from per- 
ceiving this slow, chorded, and intermitting pulse more 
frequently in children than in adults. Impressed with this 
idea, I requested Mr. Coxe, one of my pupils, to assist me 

* Vergasca, Sorbait, and Boate in Halter's Bibliotheca Medicine, vol. 
Hi. also by Dr. Stubbs in the Philosophical Trausactions, and Riverius in 
his treatise de febre pestilenti. 

f Vol. ii. 



BILIOUS YELLOW FEVER OF 1793. 55 

in examining the state of the eyes. For two days we disco- 
vered no change in them, but on the third day after we 
begun to inspect thein, we both perceived a preternatural 
dilatation of the pupils, in different patients; and we seldom 
afterwards saw an eye in which it was absent. In Dr. Say 
it was attended by a squinting, a symptom which marks 
a high degree of a morbid affection of the brain. Had this 
slowness or intermission in the pulse occurred only after 
signs of inflammation or congestion had appeared in the 
brain, I should have supposed that it had been derived 
wholly from that cause ; but I well recollect having felt it 
several days before I could discover the least change in the 
pupil of the eye. I am forced therefore to call in the 
operation of another cause, to assist in accounting for this 
state of the pulse, and this I take to be a spasmodic affec- 
tion accompanied with preternatural dilatation or contrac- 
tion of the heart. Lieutaud mentions this species of pulse 
in several places, as occurring with an undue enlargement 
of that muscle.* Dr. Ferriar describes a case, in which a 
low, irregular, intermitting, and hardly perceptible pulse 
attended a morbid dilatation of the heart. f In a letter I re- 
ceived from Mr. Hugh Ferguson, then a student of medi- 
cine in the college of Edinburgh, written from Dublin, 
during the time of a visit to his father, and dated Septem- 
ber 30th, 1793, I find a fact which throws additional light 
upon this subject. " A case (says my young correspon- 
dent) where a remarkable intermission of pulse was observ- 
ed, occurred in this city last year. A gentleman of the 
medical profession, middle aged, of a delicate habit of body, 
and who had formerly suffered phthisical attacks, was attacked 
Avith the acute rheumatism. Some days after he was taken 
ill, he complained of uncommon fulness, and a very peculiar 
kind of sensation about the praecordia, which it was judged 
proper to relieve by copious blood-letting. This being 
done, the uneasiness went off. It returned, however, three 
or lour times, and was as often relieved by bleeding. Dur- 
ing each of his fits (if I may call them so), the patient ex- 
perienced an almost total remission of his pains in his 
limbs; but they returned with equal or greater violence 
after blood-letting. During the fit there was an intermis 

* Historia Anatomica Medica, vol. ii. obs. 405, 418, 42;"!. 510. 
| Medical Histories and Reflections, p. 150 



56 AN ACCOUNT OF THE 

sion of the pulse (the first time) of no less than thirteen 
strokes. It was when beating full, strong, and slow. 1 ne 
third intermission was of nine strokes. The gentleman 
soon recovered, and has enjoyed good health for ten months 
past. The opinion of some of his physicians was, that 
the heart was affected, as a muscle, by the rheumatism, and 
alternated with the limbs." . . 

I am the more inclined to believe the peculiarity in the 
pulse, which has been mentioned in the yellow fever, arose 
in part from a spasmodic affection of the heart, from the 
frequency of an uncommon palpitation of this muscle, 
which I discovered in this disease, more especially in old 
people. The disposition, likewise, to syncope and sighing, 
which so often occurred, can be explained upon no other 
principle than inflammation, spasm, dilatation, or conges- 
tion in the heart. After the 10th of September this unde- 
scribable or sulky pulse (for by the latter epithet I some- 
times called it) became less observable, and in proportion 
as the weather became cool, it totally disappeared. It was 
gradually succeeded by a pulse full, tense, quick, and as 
frequent as in pleurisy or rheumatism. It differed, how- 
ever, from a pleuritic or rheumatic pulse, in imparting a 
very different sensation to the fingers. No two strokes 
seemed to be exactly alike. Its action was of a hobbling 
nature. It was at this time so familiar to me that I think 
I could have distinguished the disease by it without seeing 
the patient. It was remarkable that this pulse attended 
the yellow fever even when it appeared in the mild form of 
an intermittent, and in those cases where the patients were 
able to walk about or go abroad. It was nearly as tense 
in the remissions and intermissions of the fever as it was 
in the exacerbations. It was an alarming symptom, and 
when the only remedy which was effectual to remove it 
was neglected, such a change in the system was induced 
as frequently brought on death in a few days. 

This change of the pulse, from extreme" lowness to ful- 
ness and activity, appeared to be owing to the diminution 
of the heat of the weather, which by its stimulus, added 
to that of the remote cause, had induced those symptoms 
of depression of the pulse which have been mentioned. 

The pulse most frequently lessened in its fulness, and 
became gradually weak, frequent, and imperceptible before 



BILIOUS YELLOW FEVER OF 1793. 57 

death, but I met with several cases in which it was full, 
active, and even tense in the last hours of life. 

Hemorrhages belong to the symptoms of this fever as 
thej r appeared in the sanguiferous system. They occur- 
red in the beginning of the disease, chiefly from the nose 
and uterus. Sometimes but a few drops of blood distil- 
led from the nose. The menses were unusual in their quan- 
tity when they appeared at their stated periods, but they 
often came on a week or two before the usual time of their 
appearance. I saw one case of a haemorrhage from the 
lungs on the first day of the fever, which was supposed to 
be a common haemoptysis. As the disease advanced the 
discharges of blood became more universal. They occur- 
red from the gums, ears, stomach, bowels, and urinary 
passages. Drops of blood issued from the inner canthus 
of the left eye of Mr. Josiah Coates. Dr. Woodhouse at- 
tended a lady who bled from the holes in her ears which 
had been made by ear-rings. Many bled from the orifices 
which had been made by bleeding, several days after they 
appeared to have been healed, and some from wounds 
which had been made in veins in unsuccessful attempts to 
draw blood. These last haemorrhages were very trouble- 
some, and in some cases precipitated death. 

II. I come now to mention the symptoms of this fever 
as they appeared in tlie liver, the lungs and the brain. 
From the histories which I had read of this disease, I was 
early led to examine the state of the liver, but I was sur- 
prised to find so few marks of hepatic affection. I met with 
but two cases in which the patient could lie only on the 
right side. Many complained of a dull pain in the region 
of the liver, but very few complained in the beginning of 
the disease, of that soreness to the touch, about the pit of 
the stomach, which is taken notice of by authors, and which 
was universal in the yellow fever in 1762. In proportion 
as the cool weather advanced, a preternatural determination 
of the blood took place chiefly to the lungs and brain. 
Many were affected with pneumonic symptoms, and some 
appeared to die of sudden effusions of blood or serum in 
the lungs. It was an unexpected effusion of this kind 
which put an end to the life of Mrs. Kepple after she had 
exhibited hopeful signs of a recovery. 

I saw one person who recovered from an affection of the 

VOL. III. H 



58 AN ACCOUNT OF THE 

lungs, by means of a copious expectoration of yellow phlegm 
and mucus. But the brain was principally affected with 
morbid congestion in this disease. It was indicated by the 
suffusion of blood in the face, by the redness of the eyes, 
by a dilation of the pupils, by the pain in the head, by the 
hemorrhages from the nose and ears, by the sickness or 
vomiting, and by an almost universal costive state of the 
bowels. I wish to impress the reader with these facts, for 
they formed one of the strongest indications for the use of 
the remedies which I adopted for the cure of this disease. 
It is difficult to determine the exact state of these viscera in 
every case of bilious and yellow fever. Inflammation cer- 
tainly takes place in some cases, and internal haemorrhages 
in others ; but I believe the most frequent affection of these 
viscera consists in a certain morbid accumulation of blood in 
them, which has been happily called, by Dr. Clark, an en- 
gorgement or choaking of the blood-vessels. 1 believe further, 
with Dr. Clark* and Dr. Balfour,f that death in most cases 
in bilious fevers is the effect of these morbid congestions, 
and wholly unconnected with an exhausted state of the sys- 
tem, or a supposed putrefaction in the fluids. It is true, 
the dissections of Dr. Physick and Dr. Cathrall (to be 
mentioned hereafter) discovered no morbid appearance^ in 
any of the viscera which have been mentioned, but it should 
be remembered, that these dissections were made early in 
the disease. Dr. Annan attended the dissection of a brain 
of a patient who died at Bush-hill some days afterwards, and 
observed the blood-vessels to be unusually turgid. In those 
cases where congestion only takes place, it is as easy to 
conceive that all morbid appearances in the brain may cease 
after death, as that the suffusion of blood in the face should 
disappear after the retreat of the blood from the extremities 
of the vessels, in the last moments of life. It is no new 
thing for morbid excitement of the brain to leave either 
slender, or no marks of disease after death. This, I have 
said, is often the case where it exceeds that degree of action 
which produces an effusion of red blood into serous vessels, 
or what is called inflammation.^ Dr. Quin has given a 
dissection of the brain of a child that died with all the 
symptoms of hydrocephalus interims, and yet nothing was 

I X°\ •'' P ' \- 68 v J" Treatise r : n the Intestinal Remitting Fever, p. 125. 
% Outlines ot the phenomena ol fever. v 



BILIOUS YELLOW FEVER OF 1793. 59 

discovered in the brain but a slight turgescence of its blood- 
vessels. Dr. Girdlestone says, no injury appeared in the 
brains of those persons who died of the symptomatic apo- 
plexy, which occurred in a spasmodic disease, which he 
describes, in the East-Indies ; and Mr. Clark informs us, 
that the brain was in a natural state in every case of death 
from puerperile fever, notwithstanding it seemed to be af- 
fected in many cases soon after the attack of that disease.* 

I wish it to be remembered here, that the yellow fever, 
like all other diseases, is influenced by climate and seasons. 
The determination of the fluids is seldom the same in dif- 
ferent years, and I am sure it varied with the weather in the 
disease which I am now describing. Dr. Jackson speaks 
of the head being most affected in the West India fevers in 
dry situations. Dr. Hillary says, that there was an unusu- 
al determination of the blood towards the brain, after a hot 
and dry season, in the fevers of Barbadoes in the year 1753; 
and Dr. Ferriar, in his account of an epidemic jail fever in 
Manchester, in 1789, 1790, informs us, that as soon as 
frost set in, a delirium became a more frequent symptom 
of that disease, than it had been in more temperate weather. 

III. The stomach and bowels were affected in many ways 
in this fever. The disease seldom appeared without nau- 
sea or vomiting. In some cases they both occurred for 
several days or a week before they were accompanied by 
any fever. Sometimes a pain, known by the name of gas- 
trodynia, ushered in the disease. The stomach was so 
extremely irritable as to reject drinks of every kind. Some- 
times green or yellow bile was ejected on the first day of 
the disease by vomiting ; but I much oftener saw it conti- 
nue for two days without discharging any thing from the 
stomach, but the drinks which were taken by the patient. 
If the fever in any case came on without vomiting, or if it 
had been checked by remedies that were ineffectual to re- 
move it altogether, it generally appeared, or returned, on 
the 4th or 5th day of the disease. I dreaded this symptom 
on those days, for although it was not always "the fore- 
runner of death, yet it generally rendered the recovery 
more difficult and tedious. In some cases the vomiting 
was more or less constant from the beginning to the end 
of the disease, whether it terminated in life or death. 

• Essay on the Epidemic Diseases of Lying-in Women, of the vear-: 
1787 and 1788, p. 34, 



60 AN ACCOUNT OF THE 

The vomiting which came on about the 4th or 5th day, 
was accompanied with a burning pain in the region of the 
stomach. It produced great anxiety, and tossing of the 
body from one part of the bed to another. In some cases, 
this'painful burning occurred before any vomiting had ta- 
ken place. Drinks were now rejected from the stomach 
so suddenly, as often to be discharged over the hand that 
lifted them' to the head of the patient. The contents of the 
stomach (to be mentioned hereafter) were sometimes thrown 
up with a convulsive motion, that propelled them in a 
stream to a great distance, and in some cases all over the 
clothes of the by standers. 

Flatulency was an almost universal symptom, in every 
stage of this disease. It was very distressing in many cases. 
It occurred chiefly in the stomach. 

The bowels were generally costive, and in some patients 
as obstinately so as in the dry gripes. In some cases there 
was all the pain and distress of a bilious colic, and in others, 
the tenesmus, and mucous and bloody discharges of a true 
dysentery. A diarrhoea introduced the disease in a few 
persons, but it was chiefly in those who had been previous- 
ly indisposed with weak bowels. A painful tension of the 
abdomen took place in many, accompanied in some instan- 
ces by a dull, and in others by an acute pain in the lower 
part of the belly. 

IV. I come now to describe the state of the secretions 
and excretions as they appeared in different stages of this fever. 

In some cases there was a constipation of the liver, if I 
may be allowed that expression, or a total obstruction of 
secretion and excretion of bile, but more frequently a pre- 
ternatural secretion and excretion of it took place. It was 
discharged, in most cases, from the stomach and bowels in 
large quantities, and of very different qualities and colours. 

1. On the first and second days of the disease many pa- 
tients puked from half a pint to nearly a quart of green or 
yellow bile. Four cases came under" my notice in which 
black bile was discharged on the first day. Three of these 
patients recovered. 

C. There was frequently, on the 4th or 5th day, a dis- 
charge of matter from the stomach, resembling coffee im- 
pregnated with its grounds. This was always an alarming 
symptom. I believed it at first to be a modification of vi- 



BILIOUS YELLOW FEVER OF 1793. 61 

tiated bile, but subsequent dissections by Dr. Physick have 
taught me that it was the result of the first stage of those 
morbid actions in the stomach, which afterwards produce 
the black vomit. Many recovered who discharged this cof- 
fee-coloured matter. 

3. Towards the close of this disease, there was a dis- 
charge of matter of a deep or pale black colour, from the 
stomach. Flakey substances frequently floated in the bason 
or chamber-pot upon the surface of this matter. It was 
what is called the black vomit. It was formerly supposed 
to be vitiated bile, but it has been proved by Dr. Stewart, 
and afterwards by Dr. Physick, to be the effect of disease 
in the stomach. 

4. There was frequently discharged from the stomach in 
the close of the disease, a large quantity of grumous blood, 
whjch exhibited a dark colour on its outside, resembling 
that of some of the matters which have been described, and 
which I believe was frequently mistaken for what is com- 
monly known by the name of the black vomit. Several of 
my patients did me the honour to say, I had cured them 
after that symptom of approaching dissolution had made its 
appearance ; but I am inclined to believe, dark-coloured 
blood, only, or the cofFee-coioured matter, was mistaken 
for the matters which constitute the fatal black vomiting. 
I except here the black discharge before mentioned, which 
took place in three cases on the first day of the disease. This 
I have no doubt was bile, but it had not acquired its greatest 
acrimony, and it was discharged before mortification, or 
even inflammation could have taken place in the stomach. 
Several persons died without a black vomiting of any kind. 

Along with all the discharges from the stomach which 
have been described, there was occasionally a large worm, 
and frequently large quantities of mucus and tough phlegm. 

The colour, quality, and quantity of the faces depended 
very much upon the treatment of the disease. Where ac- 
tive purges had been given, the stools were copious, foetid, 
and of a black or dark colour. Where they were sponta- 
neous, or excited by weak purges, they had a more natu- 
ral appearance. In both cases they were sometimes of a 
green, and sometimes of an olive colour. Their smell was 
more or less foetid,, according to the time in whicn they had 
been detained in the bowels. I visited a lady who had pass- 



62 AN ACCOUNT OF THE 

ed several days without a stool, and who had been treated 
with tonic remedies. I gave her a purge, which ma few 
hours procured a discharge of fasces, so extremely foetid, 
that they produced fainting in an old woman who attended 
her. The acrimony of the faeces was such as to excoriate 
the rectum, and sometimes to produce an extensive inflam- 
mation all around its external termination. The quantity 
of stools produced by a single purge was in many cases 
very great. They could be accounted for only by calling 
in the constant and rapid formation of them, by preterna- 
tural effusions of bile into the bowels. 

I attended one person, and heard of two others, in whom 
the stools were as white as in the jaundice. I suspected, 
in these cases, the liver to be so constipated or paralyzed 
by the disease, as to be unable to secrete or excrete bile to 
colour the faeces. Large round worms were frequently 
discharged with the stools. 

The urine was in some cases plentiful, and of a high 
colour. It was at times clear, and at other times turbid. 
About the 4th or 5th day, it sometimes assumed a dark 
colour, and resembled strong coffee. This colour, con- 
tinued, in one instance, for several days after the patient 
recovered. In some, the discharge was accompanied by a 
burning pain, resembling that which takes place in a go- 
norrhoea. I met with one case in which this burning came 
on only in the evening, with the exacerbation of the fever, 
and went off with its remission in the morning. 

A total deficiency of the urine took place in many peo- 
ple for a day or two, without pain. Dr. Sydenham takes 
notice of the same symptom in the highly inflammatory 
small-pox.* It generally accompanied or portended great 
danger. I heard of one case in which there was a suppres- 
sion of urine, which could not be relieved without the use 
of the catheter. 

A young man was attended by Mr. Fisher, one of my 
pupils, who discharged several quarts of limpid urine just 
before he died. 

Dr. Arthaud informs us, in the history of a dissection 
of a person who died of the yellow fever, that the urine 
after death imparted a green colour to the tincture of ra- 
dishes, f 

* Wallace's edition, vol. i. p. 197. 

t Rosier's Journal for January, 1790. vol. xxxvi. p. 380. 



BILIOUS YELLOW FEVER OF 1793. 63 

Many people were relieved by copious sweats on the 
first day of the disease. They were in some instances 
spontaneous, and in others they were excited by diluting 
drinks, or by strong purges. These sweats were often of 
a yellow colour, and sometimes had an offensive smell. 
They were in some cases cold, and attended at the same 
time with a full pulse. - In general, the skin was dry in 
the beginning, as well as in the subsequent stages of the 
disease. I saw but few instances of its terminating like 
common fevers, by sweat, after the third day. I wish this 
fact to be remembered by the reader, for it laid part of the 
foundation of my method of treating this fever. 

There was in some cases a preternatural secretion and 
excretion of mucus from the glands of the throat. It was 
discharged by an almost constant hawking and spitting. 
All who had this symptom recovered. 

The tongue was in every case moist, and of a white 
colour, on the first and second days of the fever. As the 
disease advanced, it assumed a red colour, and a smooth 
shining appearance. It was not quite dry in this state. 
Towards the close of the fever, a dry black streak appear- 
ed in its middle, which gradually extended to every part of 
it. Few recovered after this appearance on the tongue took 
place. 

V. In the nervous system the symptoms of the fever 
were different, according as it affected the brain, the mus- 
cles, the nerves, or the mind. The sudden and violent 
action of the miasmata induced apoplexy in several people. 
In some, it brought on syncope, and in others, convulsions 
in every part of the body. The apoplectic cases generally 
proved fatal, for they fell chiefly upon hard drinkers. Per- 
sons affected by syncope, or convulsions, sometimes fell 
down in the streets. Two cases of this kind happened 
near my house. One of them came under my notice. He 
was supposed by the by-standers to be drunk, but his 
countenance and convulsive motions soon convinced me 
that this was not the case. 

A coma was observed in some people, or an obstinate 
wakefulness in every stage of the disease. The latter 
symptom most frequently attended the convalescence. 
Many were affected with immobility, or numbness in their 
1 i 111 ' 



64 AN ACCOUNT OF THE 

These symptoms were constant, or temporary, according 
to the nature of the remedies which were made use of to 
remove them. They extended to all the limbs, in some 
cases, and only to a part of them in others. In some, a 
violent cramp, both in the arms and legs, attended the first 
attack of the fever. I met with one case in which there 
was a difficulty of swallowing, from a spasmodic affection 
of the throat, "such as occurs in the locked jaw. 

A hiccup attended the last stage of this disease, but I 
think less frequently than the last stage of the common 
bilious fever. I saw but five cases of recovery where this 
symptom took place. 

There was, in some instances, a deficiency of sensibility, 
but in others, a degree of it extending to every part of the 
body, which rendered the application of common rum to 
the skin, and even the least motion of the limbs, painful. 

I was surprised to observe the last stage of this fever to 
exhibit so few of the symptoms of the common typhus or 
chronic fever. Tremors of the limbs and twitchings of the 
tendons were uncommon. They occurred only in those 
cases in which there was a predisposition to nervous dis- 
eases, and chiefly in the convalescent state of the disease. 

While the muscles and nerves in many cases exhibited 
so many marks of preternatural weakness, in some they 
appeared to be affected with preternatural excitement. 
Hence patients in the close of the disease often rose from 
their beds, walked across their rooms, or came down stairs, 
with as much ease as if they had been in perfect health. I 
lost a patient in whom this state of morbid strength occur- 
red to such a degree, that he stood up before his glass and 
shaved himself, on the day upon which he died. 

The mind suffered with the morbid states of the brain 
and nerves. A delirium was a common symptom. It 
alternated in some cases with the exacerbations and remis- 
sions of the fever. In some it continued without a remis- 
sion, until a few hours before death. Many, however, 
passed through the whole course of the disease without 
the least derangement in their ideas, even where there weft 
evident signs of morbid congestion in the brain. Some 
were seized with maniacal symptoms. In these there was 
an apparent absence of fever. Such was the degree of this 
mania in one man, that he stripped off his shirt, left his bed, 



BILIOUS YELLOW FEVER OF 1793. 65 

and ran through the streets, with no other covering than a 
napkin on his head, at 8 o'clock at night, to the great terror 
of all who met him. The symptoms of mania occurred 
most frequently towards the close of the disease, and some- 
times continued for many days and weeks, after all other 
febrile symptoms had disappeared. 

The temper was much affected in this fever. There 
were few in whom it did not produce great depression of 
spirits. This was the case in many, in whom pious habits 
had subdued the fear of death. In some the temper be- 
came very irritable. Two cases of this kind came under 
my notice, in persons who, in good health, were distin- 
guished for uncommon sweetness of disposition and man- 
ners. 

I observed in several persons the operations of the under- 
standing to be unimpaired throughout the whole course 
of the fever, who retained no remembrance of any thing 
that passed in their sickness. My pupil, Mr. Fisher, fur- 
nished a remarkable example of this correctness of under- 
standing, with a suspension of memory. He neither said 
nor did any thing, during his illness, that indicated the 
least derangement of mind, and yet he recollected nothing 
that passed in his room, except my visits to him. His 
memory awakened upon my taking him by the hand, on 
the morning of the 6th day of his disease, and congratulat- 
ing him upon his escape from the grave. 

In some, there was a weakness, or total defect of memory, 
for several weeks after their recover)-. Dr. Woodhouse 
informed me that he had met with a woman, who, after 
she had recovered, could not recollect her own name. 

Perhaps it would be prober to rank that self-deception 
with respect to the nature and danger of the disease, which 
was so universal, among the instances of derangement of 
mind. 

The pain which attended the disease was different, ac- 
cording to the different states of the system. In those 
eases in which it sunk under the violence of the disease, 
there was little or no pain. In proportion as the system 
was relieved from this oppression it recovered its sensibility. 
The pain in the head was acute and distressing. It affect- 
ed the eye-balls in a peculiar manner. A pain extended, 
in some cases, from the back of the head down the neck, 

VOL. III. I 



66 AN ACCOUNT OF THE 

The ears were affected, in several persons, with a painful 
sensation, which they compared to a string drawing their 
two ears together through the brain. The sides, and the 
regions of the stomach, liver, and bowels, were all, in dif- 
ferent people, the seats of either dull or acute pains. The 
stomach, towards the close of the disease, was affected with 
a burning or spasmodic pain of the most distressing nature. 
It produced in some cases, great anguish of body and mind. 
In others it produced cries and shrieks, which were often 
he rd on the opposite side of the streets to where the patients 
lay. The back suffered very much in this disease. The 
stoutest men complained, and even groaned under it. An 
acute pain extended, in some cases, from the back to one, 
or both thighs. The arms and legs sympathized with every 
other part of the body. One of my patients, upon whose 
limbs the disease fell with its principal force, said that his 
legs felt as if they had been scraped with a sharp instru- 
ment. The sympathy of friends with the distresses of the 
sick extended to a small part of their misery, when it did 
not include their sufferings from pain. One of the dearest 
friends I ever lost by death declared, in the height of her 
illness, that " no one knew the pains of a yellow fever, but 
those who felt them." 

VI. The senses and appetites exhibited several marks of 
the universal ravages of this fever upon the body. A deaf- 
ness attended in many casts, hut it was not often, as in the 
nervous fever, a favourable symptom. A dimnese of sight 
was very common in the beginning of the disease. Many 
were affected with temporary blindness. In some there was 
a loss of sight in consequence of gutta serena, or a total de- 
struction of the substance of the eye. There was in many 
persons a soreness to the touch which extended all over the 
bod}'. I have often observed this symptom to be the fore- 
runner of a favourable issue of a nervous fever, but it was 
less frequently the case in this disease. 

The thirst was moderate or absent in some cases, but it 
occurred in the greatest number of persons whom I saw in 
this fever. Sometimes it was very intense. One of my 
patients, who suffered by an excessive draught of cold 
water, declared, just before he died, that " he could drink 
up the Delaware." It was always an alarming symptom 
when this thirst came on in this extravagant degree in the 



BILIOUS YELLOW FEVER OF 1793. 67 

last stage of the disease. In the beginning of the fever it 
generally abated upon the appearance of a moist skin. 
Water was preferred to all other drinks. 

The appetite for lood was impaired in this, as in all 
other fevers, but it returned much sooner than is common 
after the patient began to recover. Coffee was relished in 
the remissions of the fever, in every stage of the disease. 
So keen was the appetite for solid, and more especially for 
animal food, after the solution of the fever, that many suf- 
fered from eating aliment that was improper from its quali- 
ty or quantity. There was a general disrelish for wine, but 
malt liquors were frequently grateful to the taste. 

Many people retained a relish for tobacco much longer 
after the)' were attacked by this fever, and acquired a relish 
for it much sooner after they began to recover, than are com- 
mon in any other febrile disease. I met with one case in which 
a man, who was so ill as to require two bleedings, conti- 
nued to chew tobacco through every stage of his fever. 

The convalescence from this disease was marked, in some 
instances, by a sudden revival of the venereal appetite. 
Several weddings took place in the city between persons 
who had recovered from the fever. Twelve took place 
among the convalescents in the hospital at Bush-hill. I 
wish I could add that the passion of the sexes for each other, 
among those subjects oi public charity, was always gratifi- 
ed only in a lawful way. Delicacy forbids a detail of the 
scenes of debauchery which were practised near the hospi- 
tal, in some of the tents which had been appropriated for 
the reception of convalescents. It was not peculiar to this 
fever to produce this morbid excitability of the venereal 
appetite. It was produced in a much higher degree by the 
plague which raged in Messina in the year 1743. 

VII. The lymphatic and glandular system did not escape 
without some signs of this disease. I met with three cases 
of swellings in the inguinal) two in the parotid, and one in 
the cervical glands : all these patients recovered without a 
suppuration of their swellings. They were extremely pain- 
ful in one case in which no redness or inflammation appear- 
ed. In the others there was considerable inflammation and 
but little pain. 

In one of the cases of inguinal buboes, the whole force 
of the disease seemed to be collected into the lymphatic 



68 AN ACCOUNT OF THE 

system. The patient walked about, and had no fever nor 
pain in any part of his body, except in his groin. In ano- 
ther case which came under my care, a swelling and pain 
extended from the groin along the spermatic cord into one 
of the testicles. These glandular swellings were not pecu- 
liar to this epidemic. They occurred in the yellow fever 
of Jamaica, as described by Dr. Williams, and always with 
a happy issue of the disease.* A similar concentration of 
the whole force of the plague in the lymphatic glands is 
taken notice of by Dr. Patrick Russel. 

VIII. The skin exhibited many marks of this fever. It 
was preternaturally warm in some cases, but it was often 
preternaturaliy cool. In some there Mas a distressing cold- 
ness in the limbs for two or three days. The yellow colour 
from which this fever has derived its name, was not uni- 
versal. It seldom appeared where purges had been given 
in sufficient doses. The yellowness rarely appeared before 
the third, and generally about the fifth or seventh day of the 
fever. Its early appearance always denoted great danger. 
It sometimes appeared first on the neck and breast, instead 
of the eyes. In one of my patients it discovered itself first 
behind one of his ears, and on the crown of his head, which 
had been bald for several years. The remissions and exa- 
cerbations of the fever seemed to have an influence upon 
this colour, for it appeared and disappeared altogether, or 
with fainter or deeper shades of yellow, two or three times 
in the course of the disease. The eyes seldom escaped a 
yellow tinge ; and yet I saw a number of cases in which the 
disease appeared with uncommon malignity and danger, 
without the presence of this symptom. 

There was a clay-coloured appearance in the face, in 
some cases, which was very different from the vellow co- 
lour which has been described. It occurred in the last 
stage of the fever, and in no instance did I see a recovery 
after it. 

There were eruptions of various kinds on the skin, each 
of which I shall briefly describe. 

1. I met with two cases of an eruption on the skin, re- 
sembling that which occurs in the scarlet fever. Dr. Hume 
says, pimples often appear on the pit of the stomach, in the 
yellow fever of Jamaica. I examined the external'region 

* Essay on the Bilious or Yellow Fever, p 35. 



BILIOUS YELLOW FEVER OF 1793. 69 

of the stomach in many of my patients, without discover- 
ing them. 

2. I met with one case in which there was an eruption 
of watery blisters, which, after bursting, ended in deep, 
black sores. 

3. There was an eruption about the mouth in many peo- 
ple, which ended in scabs, similar to those which take place 
in the common bilious fever. They always afforded a pros- 
pect of a favourable issue of the disease. 

4. Many persons had eruptions which resembled mos- 
qucto bites. They were red and circumscribed. They 
appeared chiefly on the arms, but they sometimes extended 
to the breast. Like the yellow colour of the skin, they ap- 
peared and disappeared two or three times in the course of 
the disease. 

5. Petechia? were common in the latter stage of the fever. 
They sometimes came on in large, and at other times in 
small red blotches ; but they soon acquired a dark colour. 
In most cases they were the harbingers of death. 

6. Several cases of carbuncles, such as occur in the 
plague, came under my notice. They were large and hard 
swellings on the limbs, with a black apex, which, upon 
being opened, discharged a thin, dark -coloured, bloody 
matter. From one of these malignant sores a haemorrhage 
took place, which precipitated the death of the amiable 
widow of Dr. John Morris. 

7. A large and painful anthrax on the back succeeded a 
favourable issue of the fever in the Rev. Dr. Blackwell. 

8. I met with a woman who showed me the marks of a 
number of small biles on her face and neck, which accom- 
panied her fever. 

Notwithstanding this disposition tp cutaneous eruptions 
in this disease, it was remarkable that blisters were much 
less disposed to mortify than in the common nervous fever. 
I met with only one case in which a deep-seated ulcer fol- 
lowed the application of blisters to the legs. Such was the 
insensibility of the skin in some people, that blisters made 
no impression upon it. 

IX. The blood in this fever has been supposed to under- 
go a change from a healthy to a putrid state, and many of 
its symptoms which have been described, particularly the 
haemorrhages and eruptions on the skin, have been ascribed 



70 AN ACCOUNT OF THE 

to this supposed putrefaction of the blood. It would be 
easy to multiply arguments, in addition to those mentioned 
in another place,* to prove that no such thing as putrefac- 
tion can take place in the blood, and that the symptoms 
which have been supposed to prove its existence are all 
effects of a sudden, violent, and rapid inflammatory action 
or pressure upon the blood-vessels, and hence the external 
and internal haemorrhages. The petechias on the surface 
of the skin depend upon the same cause. They are no- 
thing but effusions of serum or red blood, from a rupture 
or preternatural dilatation of the capillary vessels, f The 
smell emitted from persons affected by this disease was far 
from being of a putrid nature ; and if this had been the 
case, it would not have proved the existence of putrefac- 
tion in the blood, for a putrid smell is often discharged 
from the lungs, and from the pores in sweat, which is wholly 
unconnected with a putrid, or perhaps any other morbid 
state of the blood. There are plants which discharge an 
odour which conveys to the nose a sensation like that of 
putrefaction ; and yet these plants exist, at the same time, 
in a state of the most healthy vegetation : nor does the 
early putrid smell of a body which perishes with this fever 
prove a putrid change to have taken place in the blood be- 
fore death. All animals which die suddenly, and without 
loss of blood, are disposed to a speedy putrefaction. This 
has long been remarked in animals that have been killed 
after a chase, or by lightning. The poisonous air called 
samiel, which is described by Chardin, produces, when it 
destroys life, instant putrefaction. The bodies of men who 
die of violent passions, or after strong convulsions, or even 
after great muscular exertion, putrefy in a few hours after 
death. The healthy^ state of the body depends upon a 
certain state of arrangement in the fluids. A derangement of 
these fluids is the natural consequence of the violent and 
rapid motions, or of the undue pressure upon the solids, 
which have been mentioned. It occurs in cases of death 
which are induced by the excessive force of stimulus, whe- 

* Outlines of the phenomena of fever. 

t See Waliis's edition of Sydenham, vol. i. p. 165. vol. ii. p. 52, 94, 98, 
350; De Haen's Ratio Medendi, vol. ii. p. 162. vol. iv. p 172; Gaubit 
Pathologia. sect. 498; and Dr. Scvberts inaugural dissertation, entitled 
" An Attempt to disprove tlie Drctrine of Putrefaction of the Blood in 
Living Animals," published in Philadelphia in 1793. 



BILIOUS YELLOW FEVER OF 1793. 71 

ther it be from miasmata, or the volatile vitriolic acid 
which is supposed to constitute the destructive samiel wind, 
or from violent commotions excited in the body by exter- 
nal or internal causes. The practice among fishermen, in 
some countries, of breaking the heads of their fish as soon 
as they arc taken out of the water, in order to retard their 
putrefaction, proves the truth of the explanation I have 
given of its cause, soon after death. The sudden extinc- 
tion of life in the fish prevents those convulsive or violent 
motions, which induce sudden disorganization in their 
bodies. It was observed that putrefaction took place most 
speedily after death from the yellow fever, where the com- 
motions of the system were not relieved by evacuations. 
In those eases where purges and bleeding had beeen used, 
putrefaction did not take place sooner after death than is 
common in any other febrile disease, under equal circum- 
stances of heat and air. 

Thus I have described the symptoms of this fever. 
From the history I have given, it appears that it counter* 
feited nearly all the acute and chronic forms of disease to 
which the human body is subject. An epitome, both of 
its symptoms and its theory, is happily delivered by Dr. 
Sydenham, in the following words. After describing the 
epidemic cough, pleurisy, and peripneumony of 1675, he 
adds, " But in other epidemics, the symptoms are so slight 
from the disturbance raised in the blood by the morbific 
particles contained in the mass, that nature being in a 
manner oppressed, is rendered unable to produce regular 
symptoms that are suitable to the disease ; and almost all 
the phenomena that huppen are irregular, by reason of the 
entire subversion of the animal economy ; in which case 
the fever is often depressed, which,, of its own nature, 
would be very high. Sometimes also fewer signs of a 
fever appear than the nature of the disease requires, from 
a translation of the malignant cause, either to the nervous 
system, or to some other parts of the bodv, or to some of 
the juices not contained in the blood ; whilst the morbific 
matter is yet turgid."* 

The disease ended in death in various ways. In some 
it was sudden ; in others it came on by gradual approach- 
In some the last hours of life were marked with great 
pain, and strong convulsions ; but in many more, death 
* Wallis's edition, vol. i, p, 344 



72 AN ACCOUNT OF THE 

seemed to insinuate itself into the system, with all the gen- 
tleness of natural sleep. Mr. Powell expired with a smile 
on his countenance. Dr. Griffitts informed me that Dr. 
Johnson exhibited the same symptom in the last hours of 
his life. This placid appearance of the countenance, in 
the act of dying, was not new to me. It frequently occurs 
in diseases which affect the brain and nerves. I lost a pa- 
tient, in the year 1791, with the gout, who not only smiled, 
but laughed, a few minutes before he expired. 

I proceed now to mention some peculiarities of the 
fever, which could not be brought in under any of the fore- 
going heads. 

In every case of this disease which came under my notice, 
there were evident remissions, or intermissions of the fever, 
or of such symptoms as were substituted for fever. I have 
long considered, with Mr. Senac, a tertian as the only ori- 
ginal type of all fevers. The bilious yellow fever indicat- 
ed its descent fromthis parent disease. I met with many 
cases of regular tertians, in which the patients were so well 
on the intermediate days as to go abroad. It appeared in 
this form in Mr. Van Berkel, the minister of the United 
Netherlands. Nor was this mild form of the fever devoid 
of danger. Many died who neglected it, or who took the 
common remedies for intermittents to cure it. It generally 
ended in a remittent before it destroyed the patient. The 
tertian type discovered itself in some people after the more 
violent symptoms of the fever had been subdued, and con- 
tinued in them for several weeks. It changed from a ter- 
tian to a quartan type in Mr. Thomas Willing, nearly a 
month after his recovery from the more acute and inflam- 
matory symptoms of the disease. 

It is nothing new for a malignant fever to appear in the 
form of a tertian. It is frequently the garb of the plague. 
Riverius describes a tertian fever which proved fatal on the 
third day, which was evidently derived from the same 
exhalation which produced a continual malignant fever.* 

The remissions were more evident in this, than in the 
common bilious fever. They generally occurred in the 
forenoon. It was my misfortune to be deprived, by the 
great number of my patients, of that command of time 
which was necessary to watch the exacerbations of tbb 
* De Febre Pestilenti, vol. xi p. 93. 



BILIOUS YELLOW FEVER OF 1793. 73 

fever under all their various changes, as to time, force, and 
duration. From all the observations that were suggested 
by visits, at hours that were seldom left to my choice, I was 
led to conclude, that the fever exhibited in different people 
all that variety of forms which has been described by Dr. 
Cleghorn, in his account of the tertian fever of minorca. A 
violent exacerbation on even days was evidently attended 
with more danger than on odd days. The same thing was 
observed bv Dr. Mitchell in the yellow fever of Virginia, 
in the year 1741. "If (says he) the exacerbations were 
on equal days, thev generally died in the third paroxysm, 
or the sixth day ; but if on unequal days, they recovered 
on the seventh." 

The deaths which occurred on the 3d, 5th, and 7th days, 
appeared frequently to be the effects of the commotions, or 
depression, produced in the system on the 2d, 4th, and 6th 
days. 

An apparent remission on the 3d day was frequently 
such as to beget a belief that the disease had run its course, 
and that all danger was over. A violent attack of the 
fever on the 4th day removed this deception, and, if a re- 
laxation had taken place in the use of proper remedies on 
the 3d day, death frequently occurred on the 5th or the 7th. 

The termination of this fever in life and death was much 
more frequent on the 3d, 5th, 7th, 9th, and 11th days, 
than is common in the mild remitting fever. Where death 
occurred on the even days, it seemed to be the effect of a 
violent paroxysm of the fever, or of great vigour of con- 
stitution, or of the force of medicines which protracted 
some of the motions of life beyond the close of the odd 
days which have been mentioned. 

1 think I observed the fever to terminate on the third 
day more frequently in August, and during the first ten days 
in September, than it did after the weather became cool. 
In this it resembled the common bilious remittents of our 
city, also the simple tertians described by Dr. Cleghorn.* 
The danger seemed to be in proportion to the tendency of 
the disease to a speedy crisis, hence more died in August 
in proportion to the number -who were affected than in Sep- 
tember or October, when the disease was left to itself. 
But, however strange after this remark it may appear, the 

* .Diseases ef Minorca, p. 185. 
VOL. III. K 



74 AN ACCOUNT OF THE 

disease yielded to the remedies which finally subdued 
it more speedily and certainly upon its first appearance in 
the city, than it'did two or three weeks afterwards. 

The disease continued for fifteen, twenty, and even thirty 
days in some people. Its duration was much influenced by 
the weather, and by the use or neglect of certain remedies 
(to be mentioned hereafter) in the first stage of the disease. 

It has been common with authors to divide the symp- 
toms of this fever into three different stages. The order I 
have pursued in the history of those symptoms will render 
this division unnecessary. ' It will I hope be more useful 
to divide the patients a'ffected with the disease into three 
classes. 

The first includes those in whom the stimulus of the 
miasmata produced coma, langour, sighing, a disposition 
to syncope, and a weak or slow pulse. 

The second includes those in whom the miasmata acted 
with less force, producing great pain in the head, and other 
parts of the body ; delirium, vomiting, heat, thirst, and a 
quick, tense, or full pulse, with obvious remissions or inter- 
missions of the fever. 

The third class includes all those persons in whom the 
miasmata acted so feebly as not to confine them to their 
beds or houses. This class of persons affected by the yel- 
low fever was very numerous. Many of them recovered 
without medical aid, or by the use of domestic prescriptions; 
many of them recovered in consequence of a spontaneous 
diarrhoea, or plentiful sweats ; many were saved by mode- 
rate bleeding and purging ; while some died, who conceiv- 
ed their complaints to be occasioned by a common cold, 
and neglected to take proper care of themselves, or to use 
the necessary means for their recovery. It is not peculiar 
to the yellow fever to produce this feeble operation upon 
the system. It has been observed in the southern states of 
America, that in those seasons in which the common bi- 
lious fever is epidemic " no body is quite well," and that 
what are called in those states " inward fevers" are univer- 
sal. The small-pox, even in the natural way, does not 
always confine the patient ; and thousands pass through the 
plague without being confined to their beds or houses. Dr. 
Hodges prescribed for this class of patients in his parlour 
in London, in the year 1665, and Dr. Patrick Russel did 



BILIOUS YELLOW FEVER OF 1793. 7^ 

the same from a chamber window fifteen feet above the 
level of the street at Aleppo. Notwithstanding the mild 
form the plague put on in these cases, it often proved fatal 
according to Dr. Russel. I have introduced these facts 
chiefly with a view of preparing the reader to reject the opi- 
nion that we had two species of fever in the city at the same 
time ; and to show that the yellow fever appears in a more 
simple form than with " strongly marked" characters ; or, 
in other words, with a yellow skin and a black vomiting. 

It is remarkable that this fever always found out the weak 
part of every constitution it attacked. The head, the lungs, 
the stomach, the bowels, and the limbs, suffered more or 
less, according as they were more or less debilitated by pre- 
vious inflammatory or nervous diseases, or by a mixture of 
both, as in the gout. 

I have before remarked, that the influenza, the scarlatina, 
and a mild bilious remittent, prevailed in the city, before 
the yellow fever made its appearance. In the course of a 
few weeks they all disappeared, or appeared with symptoms 
of the yellow fever ; so that, after the first week of Septem- 
ber, it was the solitary epidemic of the city. 

The only case like influenza which I saw after the 5th of 
September, was in a girl of 14 years of age, on the 13th of 
the month. It came on with a sneezing and cough. I was 
called to her on the third day of her disease. The instant 
I felt her pulse, I pronounced her disease to be the yellow 
fever. Her father was offended with this opinion, although 
he lived in a highly infected neighbourhood, and objected 
to the remedies I prescribed for her. In a few days she 
died. In the course of ten days, her father andlsister were 
infected, and both died, I was informed, with the usual 
symptoms of the yellow fever. 

It has been an axiom in medicine, time immemorial, that 
no two fevers of unequal force can exist long together in 
the same place. As this axiom seems to have been forgot- 
ten by many of the physician ■■. of Philadelphia, and as the 
ignorance or neglect of it led to that contrariety of opinion 
and practice, which unhappily took place in the treatment 
of the disease, I hope I shall be excused by those physi- 
cians, to whom this fact is as familiar as the most simple 
law of nature, if I fill a few pages with proofs of it, from 
praetical writers. 



76 AN ACCOUNT OF THE 

Thucydides long ago remarked, that the plague chased 
all other diseases irom Athens, or obliged them to change 
their nature, by assuming some of its symptoms. 

Dr. Sydenham makes the same remark upon the plague 
in London, in 1665. Dr. Hodges, in his account of the 
same plague, says, that " at the rise of the plague all other 
distempers went into it, but that, at its declension, it dege- 
nerated into others, as inflammations, head-ach, quinsies, 
dysenteries, small-pox, measels, fevers, and hectics, where- 
in the plague yet predominated."* 

During theprevalence of the plague in Grand Cairo, no 
sporadic disease of any kind makes its appearance. The 
same observation is made by Sauvage, in his account of the 
plague at Alais, in the province of Languedoc.f 

The small-pox, though a disease of less force than the 
plague, has often chased it from Constantinople, probably 
from its being in a declining state. But this exclusive pre- 
valence of a single epidemic is not confined to the plague 
and small pox. Dr. Sydenham's writings are full of proofs 
of the dominion of febrile diseases over each other. Hence, 
after treating upon a symptomatic pleurisy which some- 
times accompanied a slow fever, in the year 1675, and 
which had probably been injudiciously treated by some of 
those physicians who prescribe for the name of a disease, 
he delivers the following aphorism : " Whoever, in the cure 
of fevers, hath not always in view the constitution of the 
year, inasmuch as it tends to produce some particular epi- 
demic disease, and likewise to reduce all the cotemporary 
diseases to its own form and likeness, proceeds in an un- 
certain and fallacious way. "I It appears further, from the 
writings of this excellent physician, that where the monarchy 
of a single disease was not immediately acknowledged, by 
a sudden retreat of all cotemporary diseases, they were for- 
ced to do homage to it, by wearing its livery. It would 
be easy to multiply proofs of this assertion, from the nu- 
merous histories of epidemics which are to be found in his 
works. I shall mention only one or two of them. A con- 
tinual fever, accompanied by a dry skin, had prevailed for 

* Dr. Hodges' Account of the Plague in London, p. 26. 

■f Scd hoc observatu dignum fuit, omnes alios nmrbos acutos durante 
peste siluisse, et omnes morbos acutos e pestis genere Suisse. Nosoloeia 
Methodica, vol. i. p. 416. 

t Vol. i. p. 340. 



BILIOUS YELLOW FEVER OF 1793. 77 

some time in the city of London. During the continuance 
of this fever, the regular small-pox made its appearance. It 
is peculiar to the small-pox, when of a distinct nature, to 
be attended by irregular sweats before the eruption of the 
pock. The continual fever now put on a new symptom. 
It was attended by sweats in its first stage, exactly like 
those which attended the eruptive fever of the small-pox.* 
This despotism of a powerful epidemic extended itself to 
the most trifling indispositions. It even blended itself, Dr. 
S) denham tells us, with the commotions excited in the 
system by the suppression of the lochia, as well as with the 
common puerperile fever. f Dr. Morton has left testimonies 
behind him, in different parts of his works, which establish, 
in the most ample manner, the truth of Dr. Sydenham's ob- 
servations. Dr. Huxham describes the small-pox as blend- 
ing some of its symptoms with those of a slow fever, at 
Plymouth, in the year 17294 Dr. Cleghorn mentions a 
constitution of the air at Minorca, so highly inflammatory, 
" that not only tertian fevers, but even a common hurt or 
bruise required more plentiful evacuations than ordinary. "§ 
Riverius informs us, in his history of a pestilential fever that 
prevailed in France, that " united itself with phrenitis, an- 
gina, pleurisy, peripneumony, hepatitis, dysentery, and 
many other diseases. "|| 

The bilious remitting fever which prevailed in Philadel- 
phia, in 1780, chased away every other febrile disease ; and 
the scarlatina anginosa which prevailed in our city, in 
1783 and 1784, furnished a striking proof of the influence 
of epidemics over each other. In the account which I pub- 
lished of this disease, in the year 1789, there are the follow- 
ing remarks. " The intermitting fever which made its 
appearance in August was not lost during the month of 
September. It continued to prevail, but with several pe- 
culiar symptoms. In many persons it was accompanied 
by an eruption on the skin, and a swelling of the hands and 
feet. In some it was attended with sore throat, and pains 
behind the ears. Indeed such was the prevalence of the 
contagion which produced the scarlatina anginosa, that 

* Vol. i. p. 352. 

t Vol. ii. p. 164. See also p. 1, 109, 122, 204, 212, 233, 274, 355, 358-9, 

436. 
X De Acre et Morb Epidem. p. 33, 34. § Page 285. 

H Dc Febre Pertilenti, vol. ii. p. 95. 



78 AN ACCOUNT OF THE 

many hundred people complained of sore throats, without 
any other symptom of indisposition. The slightest excit- 
ing cause, and particularly cold, seldom failed of produ- 
cing the disease."* 

I shall mention only one more authority in favour of the 
influence of a single epidemic upon diseases. It is taken 
from Mr. Clark's essay on the epidemic disease of lying-irr 
women of the years 1787 and 1788. " There does not appear 
to be any thing in a parturient state which can prevent wo- 
men from being affected by the general causes of disease at 
that time; and should they become ill, their complaints will 
probably partake of the nature of the reigning epidemic"! 
I have said that the fever sometimes put on the symptoms 
of dysentery, pleurisy, rheumatism, colic, palsy, and even 
of the locked jaw. That these were not original diseases, 
but symptomatic affections only of the reigning epidemic, 
will appear from other histories of bilious fevers. Dr. 
Bi lfour tells us, in his account of the intestinal remitting 
fever of Bengal,^ tnat ** often appeared with symptoms of 
dysentery, rheumatism, and pleurisy. Dr. Cleghorn and 
Dr. Lind mention many cases of the bilious fever appear- 
in? in the form of a dysentery. Dr. Clark ascribes the 
dysentery, the diarrhoea, the colic, and even the palsy, to 
the same cause which produced the bilious fever in the 
East-Indies ;§ and Dr. Hunter, in his treatise upon the dis- 
eases of Jamaica, mentions the locked jaw as one of its 
occasional symptoms. Even the different grades of this 
fever, from the mildest intermittent to the most acute con- 
tinual fever, have been distinctly traced by lancissi to the 
same marsh exhalation. || 

However irrefragably these numerous facts and authori- 
ties established the assertion of the prevalence of but one 
powerful epidemic at a time, the proposition will receive 
fresh support, from attending to the effects of two impres- 
sions of unequal force made upon the svstem at the same 
time : only one of them is felt ; hence the gout is said to 
cure all other diseases. By its superior pain it destroys 
sensations of a less painful nature. The small-pox and 
measles have sometimes existed together in the body ; but 

* Xu' '• • J P *S e 28 * Pa S<- !32. 

§ Observations on the Diseases in Long Voyages to the East-Indies, vol. 
I. p. 13, 14, 48, 151. vol. ii. p. 99, 318, and 320. 
!l Lib. ii. cap. v. 



BILIOUS YELLOW FEVER OF 1793, 7$ 

this has, I believe, seldom occurred, where one of them 
has not been the predominating disease.* In this respect, 
this combination of epidemics only conforms to the general 
law which has been mentioned. 

I beg pardon for the length of this digression. I did 
not introduce it to expose the mistakes of those physicians, 
who found as many diseases in our city as the yellow fever 
had symptoms, but to vindicate myself from the charge of 
innovation, in having uniformly and unequivocally asserted, 
after the first week in September, that the yellow fever was 
the only febrile disease which prevailed in the city. 

Science has much to deplore from the multiplication of 
disease. It is as repugnant to truth in medicine, as poly- 
theism is to truth in religion. The physician who con- 
siders every different affection of the different systems in the 
body, or every affection of different parts of the same sys- 
tem, as distinct diseases, when they arise from one cause, 
resembles the Indian or African savage, who considers 
water, dew, ice, frost, and snow, as distinct essences ; while 
the physician who considers the morbid affections of every 
part of the body (however diversified they may be in their 
form or degrees) as derived from one cause, resembles the 
philosopher who considers dew, ice, frost, and snow, as 
different modifications of water, and as derived simply from 
the absence of heat. 

Humanity has likewise much to deplore from this pa- 
ganism in medicine. The sword will probably be sheathed 
for ever, as an instrument of death, before physicians will 
cease to add to the mortality of mankind, by prescribing 
for the names of diseases. 

The facts I have delivered upon this subject will admit 
of a very important application to the cure, not only of the 
yellow fever, but of all other acute and dangerous epidemics. 
I shall hereafter assign a final cause for the law of epide- 
mics which has been mentioned, which will discover a 
union of the goodness of the Supreme Being with one of 
the greatest calamities of human life. 

All ages were affected by this fever, but persons between 

fourteen and forty years of age were most subject to it. 

Many old people had it, but it was not so fatal to them as 

to robust persons in middle lite. It affected children of all 

* Hunter cm the Venereal Disease, Introduction, p. 3. 



80 AN ACCOUNT OF THE 

ages. I met with a violent case of the disease, in a child 
of four months, and a moderate case of it, in a child of but 
ten weeks old. The latter had a deep yellow skin. Both 
these children recovered. 

The proportion of children who suffered by this fever 
Biay be conceived from a single fact. Seventy-five per- 
sons were buried in the grave-yard of the Swedish church 
in the months of August, September and October, twenty- 
four of whom were children. They were buried chiefly 
in September and October; months in which children 
generally enjoy good health in our city. 

Men were more subject to the disease than women. 
Pregnancy seemed to expose women to it. 

The refugees from the French West- Indies universally 
escaped it. This was not the case with the natives of 
France, who had been settled in the city. 

It is nothing new for epidemics to affect persons of one 
nation, and to pass by persons of other nations, in the same 
city or country. At Nimeguen, in the year 1736, Deigner 
informs us, that the French people (two old men excepted), 
and the Jews, escaped a dysentery which was universal 
among persons of all other nations. Ramazini tells us, 
that the Jews at Modena escaped a tertian fever which 
affected nearly all the other inhabitants of the town. Shen- 
kius says, that the Dutch and Italians escaped a plague, 
which prevailed for two years in one of the towns of Swit- 
zerland ; and Dr. Bell, in an inaugural dissertation, pub- 
lished at Edinburgh, in 1779, remarks, that the jail fever, 
which attacked the soldiers of the Duke of Buccleugh's 
regiment, spared the French prisoners who were guarded 
by them. It is difficult to account for these facts. How- 
ever numerous their causes may be, a difference in diet, 
which is as much a distinguishing mark of nations as dress 
or manners, will probably be found to be one of them. 

From the accounts of the yellow fever which had been 
published by many writers, I was led to believe that the 
ne groes in our city would escape it. In consequence of 
this belief, I published the following extract in the Ameri- 
can Daily Advertiser, from Dr. Lining's history of the 
yellow fever, as it had four times appeared in Charleston, in 
South Carolina. 

" There is something very singular (says the doctor) in 



filLIOUS YELLOW FEVER OF 1793. 81 

the constitution of the negroes, • which renders them not 
liable to this fever ; for though many of them were as much 
exposed as the nurses to the infection, yet I never knew of 
one instance of this fever among them, though they are 
equally subject with the white people to the bilious fever."* 
A day or two after this publication the following letter 
from the mayor of the city, to iMr. Claypoole, the printer 
of the Mail, appeared in his paper. 

"Sir, 

" It is with peculiar satisfaction that I commu- 
nicate to the public, through your paper, that the Afri- 
can Society, touched with the distresses which arise 
from the present dangerous disorder, have voluntarily 
undertaken to furnish nurses to attend the afflicted ; and 
that, by applying to Absalom Jones and William 
Gray, both "members of that society, they may be sup- 
plied. 

MATTH. CLARKSON, 

September 6th, 1793. Mayor. 

It was not long after these worthy Africans undertook 
the execution of their humane offer of services to the sick 
before I was convinced I had been mistaken. They took 
the disease in common with the white people, and many of 
them died with it. I think I observed the greatest number 
of them to sicken after the mornings and evenings became 
cool. A large number of them were my patients. The 
disease was lighter in them than in white people* I met 
with no case of haemorrhage in a black patient. 

The tobacconists and persons who used tobacco did not- 
escape the disease. I observed snuff-takers to be more 
devoted to their boxes than usual, during the prevalence of 
the fever* 

I have remarked, formerly, that servant maids suffered 
much by the disease. They were the only patients I lost 
veral large families. I ascribe their deaths to the fol - 
lowing causes : 

1st. To the great and unusual debility induced upon 
their systems by labour in attending their masters and mis- 

iays and Observations, Physical and Literary , vol. xi page 409. 
► L. ii r. 



82 AN ACCOUNT OF THE 

tresses, or their children. Debility, according to its degrees 
and duration, seems to have had the same effect upoi 
mortality of this fever that it has upon the mortality of an 
inflammation of the lungs. When it is moderate and of 
short duration it predisposes only to a common pneumony; 
but when it is violent and protracted, in its degrees and 
duration, it predisposes to a pulmonary consumption. 

2dly. To their receiving large quantities of impure air 
into their bodies, and in a most concentrated state, by be- 
ing obliged to perform the most menial offices for the sick, 
and by washing, as well as removing foul linen, and the 
like. 

3dly. To their being left more alone in confined or dis- 
tant rooms, and thereby suffering from depression of spirits, 
or the want of a punctual supply of food and medicines. 

There did not appear to be any advantage from smelling 
vinegar, tar, camphor, or volatile salts, in preventing the 
disease. Bark and wine were equally ineffectual for that 
purpose. I was called to many hundred people who were 
infected after using one or more of them. Nor did the 
white washing walls secure families from the disease. I am 
disposed to believe garlic was the only substance that was 
in any degree useful in preventing it. I met with several 
persons who chewed it constantly, and who were much ex- 
posed to the miasmata without being infected. All other sub- 
stances seemed to do harm by begetting a false confidence 
in the mind, to the exclusion of more rational preservatives. 
I hive suspected further, that such of them as were of a 
volatile nature helped to spread the disease by affording a 
vehicle for miasmata through the air. 

There was great mortality in all those families who lived 
in wooden houses. Whether this arose from the small size 
of these houses, or from the want of cleanliness of the peo- 
ple who occupied them, or from the miasmata becoming 
more accumulated, by adhering to the wood, I am unable 
to determine. Perhaps it was the effect of the co-operation 
of all three of those causes. 

I have said, formerly, that intemperance in drinking pre- 
disposed to the disease ; but there were several instances ot 
persons having escaped it who were constantly under the 
influence of strong drink. The stimulus of anient spirits 
probably predominated over the stimulus of the miasmata. 



BILIOUS YELLOW FEVER OF 1793. 83 

and thus excited an artificial fever which defended the sys- 
tem from that which was epidemic. 

' I heard of some sea-faring people who lived on board 
their vessels who escaped the disease. The smell of the 
tar was supposed to have preserved them ; but, from its 
being ineffectual in other cases, I am disposed to ascribe 
their escape to the infected air of the city being destroyed 
by a mixture with the water of the Delaware. 

Many people who were infected in the city, were attack- 
ed by the disease in the country, but they did not propa- 
gate it, even to persons who slept in the same room with 
them. 

Dr. Lind informs us, that- many persons escaped the yel- 
low fever which prevailed in Pensacola in the year 1765, 
by retiring to the ships which lay in the harbour, and that 
when the disease had been taken, the pure air of the water 
changed it into an intermitting fever.* The same changes 
have frequently been produced in malignant fevers, by send- 
ing patients infected with them from the foul air of a city, 
into the pure air of the country. 

Persons confined in the house of employment, in the 
hospital, and in the jail, escaped the fever. The airy and 
remote situation of those buildings was probably the chief 
means of their preservation. Perhaps they derived addi- 
tional security from their simple diet, their exemption from 
hard labour, and from being constantly sheltered from heat 
and cold. 

Several families, who shut up their front and back doors 
and windows, and avoided going out of their houses except 
to procure provisions, escaped the disease. 

I have taken some pains to ascertain, whether any class 
of tradesmen escaped the fever, or whether there was any 
species of labour which protected from it. The result of 
my inquiries is as follows : three butchers only, out of 
nearly one hundred who remained in the city, died with the 
disease. Many of them attended the markets every day. 
Two painters who worked at their business during the 
whole time of the prevalence of the fever, and in exposed 
situations, escaped it. Out of forty scavengers who were 
employed in collecting and carrying away the dirt of the 
streets, only one was affected by the fever and died. Very 
Diseases of Warm Climates, p. 169. 



84 AN ACCOUNT OF THE 

few grave-diggers, compared with the number who were 
employed in that business, were infected ; and it is well 
known, that scarcely an instance was heard of persons tak- 
ing the disease, who were constantly employed in digging 
cellars. The fact is not new that grave-diggers escape ma- 
lignant fevers. It is taken notice of by Dr. Clark. 

It was said bv some physicians in the public papers, that 
the neighbourhood of the grave-yards was more infected 
than other parts of the city. The reverse of this assertion 
was true in several cases, owing probably to the miasmata 
being diluted and weakened by its mixture with the air of 
the grave-yards : for this air was pure, compared with that 
which stagnated in the streets. 

It was said further, that the disease was propagated by 
the inhabitants assembling on Sundays for public worship; 
and, as a proof of this assertion, it was reported, that the 
deaths were more numerous on Sundays than on other days; 
occasioned by the infection received on one Sunday produ- 
cing death on the succeeding first day of the week. The 
register of the deaths shows that this was not the case. I am 
disposed to believe that fewer people sickened on Sundays, 
than on any other day of the week ; owing to the general 
rest from labour, which I have before said was one of the 
exciting causes of the disease. From some facts to be 
mentioned presently, it will appear probable, that places of 
public worship, in consequence of their size, as well as of 
their being shut up during the greatest part of the week, 
were the freest from miasmata of any houses in the city. It 
is agreeable to discover in this, as well as in all other cases 
of public and private duty, that the means of health and 
moral happiness are in no one instance opposed to each 
other. 

The disease, which was at first confined to Water- street, 
soon spread through the whole city. After the 15th of 
September, the atmosphere of every street in the city was 
charged with miasmata ; and there were few citizens in ap- 
parent good health, who did not exhibit one or more of the 
following marks of their presence in their bodies. 

1. A yellowness in the eyes, and a sallow colour upon 
their skin. 

2, A preternatural quickness in the pulse. I found but 
two exceptions to this remark, out of a great number of 



BILIOUS YELLOW FEVER OF 1793. 85 

persons whose pulses I examined. In one of them it dis- 
covered several preternatural intermissions in the course of 
a minute. This quickness of pulse occurred in the negroes, 
as well as in the white people. I met with it in a woman 
who had had the yellow fever in 1762. In two women, 
and in one man above 70, the pulse beat upwards of 90 
strokes in a minute. This preternatural state of the pulse 
during the prevalence of a pestilential fever, in persons in 
health, is taken notice of by Riverius.* 

3. Frequent and copious discharges by the skin of yel- 
low sweats. In some persons these sweats sometimes had 
an offensive smell, resembling that of the washings of a 
gun. 

4. A scanty discharge of high coloured or turbid urine. 

5. A deficiency of appetite, or a greater degree of it than 
was natural. 

6. Costiveness. 

7. Wakefulness. 

8. Head-ach. 

9. A preternatural dilatation of the pupils. This was 
universal. I was much struck in observing the pupil in 
one of the eyes of a young man who called upon me for 
advice, to be of an oblong figure. Whether it was natural, 
or the effect of the miasmata acting on his brain, I could 
not determine. 

It will be thought less strange that the miasmata should 
produce these changes in the systems of persons who re- 
sided constantly in the city, when I add, that many country 
people who spent but a few hours in the streets in the day, 
in attending the markets, were infected by the disease, and 
sickened and died after they returned home; and that others, 
whom business compelled to spend a day or two in the 
city during the prevalence of the fever, but who escaped an 
attack, of it, declared that they were indisposed, during the 
whole time, with languor or head-ach. 

I was led to observe and record the above effects of the 
miasmata upon persons in apparent good health, by a fact 
I met with in Dr. Mitchell's history of the yellow fever in 
Virginia, in the year 1741. In that fever, blood drawn 
from a vein was always dissolved. The same state of the 

• " Pulsus sanorum pulsibus similes admodum, periculosi." — De Febre 
J'rsdlenti,/!. 114. 



86 AN ACCOUNT OF THE 

blood was observed in many persons who had been expos- 
ed to the miasmata, who discovered no other symptom of 
the disease. 

A woman whom I had formerly cured of a mania, who 
lived in an infected neighbourhood^, had a fresh attack of 
that disease, accompanied by an unusual menstrual flux. I 
ascribed both these complaints to the action of the mias- 
mata upon her system. 

The smell emitted from a patient, in a clean room, was 
like that of the small-pox, but in most cases of a less disa- 
greeable nature. Putrid smells in sick rooms were the ef- 
fects of the excretions, or of some other filthy matters. In 
small rooms, crowded in some instances with four or five 
sick people, there was an effluvia that produced giddiness, 
sickness at stomach, a weakness of the limbs, faintness, and 
in some cases a diarrhoea. I met with a foetid breath in one 
patient, which was not the effect of that medicine which 
sometimes produces it. 

The state of the atmosphere, during the whole month of 
September, and the first two weeks in October, favoured 
the accumulation of the miasmata in the city. 

The register of the weather shows how little the air was 
agitated by winds during the above time. In vain were 
changes in the moon expected to alter the state of the air. 
The light of the morning mocked the hopes that were rais- 
ed by a cloudy sky in the evening. The sun ceased to be 
viewed with pleasure. Hundreds sickened every day be- 
neath the influence of his rays : and even where they did not 
excite the disease, they produced a languor in the body 
unknown to the oldest inhabitant of the city, at the same 
season of the year. 

A meteor was seen at two o'clock in the morning, on or 
about the twelfth of September. It fell between Third-street 
and the hospital, nearly in a line with Pine-street. Mos- 
quetoes (the usual attendants of a sickly autumn) were un- 
commonly numerous. Here and there a dead cat added to 
the impurity of the air of the streets. It was supposed those 
animals perished with hunger in the city, in consequence 
of so many houses being deserted by the inhabitants who 
had fled into the country, but the observations of subse- 
quent years made it more probable they were destroyed by 
the same morbid state of the atmosphere which produced 
the reigning epidemic. 



BILIOUS YELLOW FEVER OF 1793. 87 

It appears further, from the register of the weather, that 
there was no rain between the 25th of August and the 15th 
of October, except a few drops, hardly enough to lay the 
dust of the streets, on the 9th of September, and the 12th 
of October. In consequence of this drought, the springs 
and wells failed in many parts of the country. The diftt in 
some places extended two feet below the surface of the 
ground. The pastures were deficient, or burnt up. There 
was a scarcity of autumnal fruits in the neighbourhood of 
the city. But while vegetation drooped or died from the want 
of moisture in some places, it revived with preternatural 
vigour from unusual heat in others. Cherry-trees blossomed, 
and apple, pear, and plum-trees bore young fruit in several 
gardens in Trenton, thirty miles from Philadelphia, in the 
month of October. 

However inoffensive uniform heat, when agitated by 
gentle breezes, may be, there is, I believe, no record of a 
dry, warm, and stagnating air having existed for any length 
of time without producing diseases. Hippocrates, in 
describing a pestilential fever, says the year in which it 
prevailed was without a breeze of wind.* The same state 
of the atmosphere, for six weeks, is mentioned in many of 
the histories of the plague which prevailed in London, in 
1665. f Even the sea air itself becomes unwholesome b^* 
stagnating; hence Dr. Clark informs us, that sailors become 
sickly after long calms in East-India voyages. | Sir John 
Pnngle delivers the following aphorism from a number of 
similar observations upon this subject : " When the heats 
come on soon, and continue throughout autumn, not mo- 
derated by winds or rains, the season proves sickly, dis- 
tempers appear early, and are dangerous." $ 

Who can review this account of the universal diffusion 
of the miasmata which produced this disease, its universal 
effects upon persons apparently in good health, and its ac- 
cumulation and concentration, in consequence of the calm- 
ness of the air, and believe that it was possible for a febrile 
disease to exist at that time in our city that was not derived 
from that source 9 

The West- India writers upon the yellow fever have said 

* " Sine aura, u qtie annus fuit" — Kfiid. 3. 

| Letter tr mi Sir John Bernard to Dr. Floyer, p. 233. % Vol. i. p. 5. 

§ Diseases ot the Arm)', p. 5. of the 7th London edition. 



88 AN ACCOUNT OF THE 

that it is seldom taken twice, except by persons who have 
spent some years in Europe or America in the interval 
between its first and second attack. I directed my inqui- 
ries to this question, and I now proceed to mention the result 
of them. I met with five persons, during the prevalence 
of die disease, who had had it formerly, two of them in the 
year 1741, and three in 1762, who escaped it in 1793, 
although they were all more or less exposed to the infection. 
One or' them felt a constant pain in her head while the dis- 
ease was in her family. Four of them were aged, and of 
course less liable to be acted upon by the miasmata than 
persons in early or middle life. Mr. Thomas Shields fur- 
nished an unequivocal proof that the disease could be taken 
after an interval of many years. He had it in the year 
1762, and narrowly escaped from a violent attack of it this 
year. Cases of reinfection were very common during the pre- 
valence of this fever. They occurred most frequently where 
the first attack had been light. But they succeeded attacks 
that were severe in Dr. Grifhtts, Dr. Mease, my pupil Mr. 
Coxe, and several others, whose cases came under my notice. 

I have before remarked that the miasmata sometimes 
excited a fever as soon as they were taken into the body r 
but that they often lay there from one to sixteen days before 
they produced the disease. How long they existed in the 
body after a recovery from the fever I could not tell, for 
persons who recovered were, in most cases, exposed to their 
action from external sources. The preternatural dilatation 
of the pupils was a certain mark of the continuance of 
some portion of them in the system. In one person who 
was attacked with the fever on the night of the 9th of Oc- 
tober, the pupils did not contract to their natural dimen- 
sions until the 7th of November. 

Having described the effects of the miasmata upon the 
body, I proceed now to mention the changes induced upon 
it by death. 

Let us first take a view of it as it appeared soon after 
death. Some new light may perhaps be thrown upon the 
proximate cause of the disease by this mode of examining 
the body. 

My information upon this subject was derived from the 
attendants upon the sick, and from the two African citizens 
who were employed in burying the dead, viz. Richard. 



BILIOUS YELLOW FEVER OF 1793. 89 

Allen and Absalom Jones. The coincidence of the infor- 
mation I received from different persons satisfied me that 
all that I shall here relate is both accurate and just. 

A deep yellow colour appeared in many cases within a 
few minutes after death. In some the skin became purple, 
and in others black. I heard of one case in which the body 
was yellow above, and black below its middle. In some 
the skin was as pale as it is in persons who die c r common 
fevers. A placid countenance was observed in many, re- 
sembling that which occurs in an easy and healthful sleep. 

Some were stiff within one hour after death. Others 
were not so for six hours afterwards. This sudden stiff- 
ness after death, Dr. Valli informs us, occurred in persons 
who died of the plague in Smyrna, in the year 1784.* 

Some grew cold soon after death, while others retained 
a considerable degree of heat for six hours, more especially 
on their backs. 

A stream of tears appeared on the cheeks of a young 
woman, which seemed to have flowed after her death. 

Some putrefied in a short time after their dissolution, 
but others had no smell for twelve, eighteen, and twenty 
hours afterwards. This absence of smell occurred in those 
cases in which evacuations had been used without success 
in the treatment of the disease. 

Many discharged large quantities of black matter from 
the bowels, and others blood from the nose, mouth, and 
bowels, after death. The frequency of these discharges 
gave rise to the practice of pitching the joints of the coffins 
that were used to bury the dead. 

The morbid appearances of the internal parts of the body, 
as exhibited by dissection after death from the yellow fever, 
are different in different countries, and in the same countries 
in different years. I consider them all as effects only of a 
stimulus acting upon the whole system, and determined 
more or less by accidental circumstances to particular viscera. 
Perhaps the stimulus of the miasmata determines the fluids 
more violently in most cases to the liver, stomach, md 
bowels, and thereby disposes them more than other parts 
to inflammation and mortification, and to similar effusions 
and eruptions with those which take place on the skin. 
There can be no doubt of the miasmata acting upon the 

* Experiments on Animal Electricity, p. 90. 
L. III. m 



90 AN ACCOUNT OF THE 

liver, and thereby altering the qualities of the bile. I tran- 
scribe, with great" pleasure, the following account of the state 
of the bile in a female slave of forty years of age, from Dr. 
Mitchell's History of the Yellow Fever, as it prevailed in 
Virginia in the years 1737 and 1741, inasmuch as it was 
part of that clue which led me to adopt one of the remedies 
on which much of the success of my practice depended. 

" The gall bladder (says the doctor) appeared outwardly 
of a deep yellow, but within was full of a black ropy coa- 
gulated atrabilis, which sort of substance obstructed the 
pori biliarii, and ductus choledochus. This atrabilis was 
hardly fluid, but upon opening the gall bladder, it retained 
its form and shape, without being evacuated, being of the 
consistence of a thin extract, and, within, glutinous and 
ropy, like soap when boiling. This black matter seemed 
so much unlike bile, that I doubted if there were any bile 
in the gall bladder. It more resembled bruised or mortfied 
blood, evacuated from the mortified parts of the liver, sur- 
rounding it, although it would stain a knife or probe thrust 
into it of a yellow colour, which with its ropy consistence, 
seemed more peculiar to a bilious humour." 

The same appearance of the bile was discovered in seve- 
ral other subjects dissected by Dr. Mitchell. 

The liver, in the above-mentioned slave, was turgid and 
plump on its outside, but on its concave surface, two thirds 
of it were of a deep black colour, and round the gall blad- 
der it seemed to be mortified and corrupted. 

The duodenum was lined on its inside, near the gall 
bladder, with a viscid ropy bile, like that which has been 
described. Its villous coat was lined with a thick fur or 
slime, which, when scraped or pealed off, the other vascu- 
lar and muscular coats of the gut appeared red and inflamed. 

The omentum was so much wasted, that nothing but its 
blood-vessels could be perceived. 

The stomach was inflamed, both on its outside and 
inside. It contained a quantity of bile of the same consis- 
tence, but of a blacker - colour than that which was found 
in the gall bladder. Its villous coat, like that of the duode- 
num was covered with fuzzy and slimy matter. It more- 
over appeared to be distended or swelled. This peculiarity 
in the inner coat of the stomach was universal in all the 
bodies that were opened, of persons who died of this disease. 

The lungs, instead of being collapsed, were inflated as in 



BILIOUS YELLOW FEVER OF 1793. 91 

inspiration. They were all over full of black or livid spots, 
On these spots were to be seen small vesicles or blisters, 
like those of an erysipelas or gangrene, containing a yellow 
humour. 

The blood-vessels in general seemed empty of blood, 
even the vena cava and its branches ; but the vena portarum 
was full and distended as usual. The blood seemed col- 
lected in the viscera ; for upon cutting the lungs, or sound 
liver or spleen, they bled freely. 

The brain was not opened in this body, but it was not 
affected in three others whose brains were examined. 

Dr. Mackittrick, in his inaugural dissertation, published 
at Edinburgh in the year 1766, " De Febre India? Occi- 
dentalis, Maligna Flava," or upon the yellow fever of the 
West-Indies, says, that in some of the patients who died of 
it, he found the liver sphacelated, the gall bladder full of 
black bile, and the veins turgid with black fluid blood. In 
others he found the liver no ways enlarged, and its " texture 
only vitiated." The stomach, the duodenum, and ilium, 
were remarkably inflamed in all cases. The pericardium 
contained a viscid yellow serum, and in a larger quantity 
than common. The urinary bladder was a little inflamed. 
The lungs were sound. 

Dr. Hume, in describing the yellow fever of Jamaica, 
informs us, that in several dead bodies which he opened, he 
found the liver enlarged and turbid with bile, and of a pale 
yellow colour. In some he found the stomach and duode- 
num inflamed. In one case he discovered black spots in 
the stomach, of the size of a crown piece. To this account 
he adds, " that he had seen some subjects opened, on whose 
stomachs no marks of inflammation could be discovered ; 
and yet these had excessive vomiting." 

Dr. Lind has furnished us with an account of the state 
of the body after death, in his short history of the yellow 
fever, which prevailed at Cadiz, in the year 1764. " The 
stomach (he says,) mesentery, and intestines, were covered 
with gangrenous spots ; there were ulcers on the orifice of 
the stomach, and the liver and lungs were of a putrid colour 
and texture."* 

To these accounts of the morbid appearances of the body 
after death from the yellow fever I shall only add the ac- 
* Diseases of Warm Climates, p. 125. 



92 AN ACCOUNT OP THE 

count of several dissections, which was given to the public 
in Mr. Brown's Gazette, during the prevalence of this epi- 
demic, by Dr. Physic and Dr. Cathrall. 

" Being well assured of the great importance of dissec- 
tions of morbid bodies in the investigation of the nature of 
diseases, we have thought it of consequence that some of 
those dead of the present prevailing malignant fever should 
be examined ; and, without enlarging on our observations, 
it appears at present sufficient to state the following facts. 

" 1st. That the brain in all parts has been found in a 
natural condition. 

" 2d. That the viscera of the thorax are perfectly sound. 
The blood, however, in the heart and veins is fluid, similar, 
in its consistence, to the blood of persons who have been 
hanged, or destroyed by electricity. 

" 3d. That the stomach, and beginning of the duodenum, 
are the parts that appear most diseased. In two persons 
who died of the disease on the 5th day, the villous mem- 
brane of the stomach, especially about its smaller end, was 
found highly inflamed ; and this inflammation extended 
through the pylorus into the duodenum, some way. The 
inflammation here was exactly similar to that induced in 
the stomach by acrid poisons, as by arsenic, which we have 
once had an opportunity of seeing in a person destroyed 
by it. 

" The bile in the gall-bladder was quite of its natural 
colour, though very viscid. 

" In another person who died on the 8th day of the dis- 
ease, several spots of extravasation were discovered between 
the membranes, particularly about the smaller end of the 
stomach, the inflammation of which had considerably abat- 
ed. Pus was seen in the beginning of the duodenum, and 
the villous membrane at this part was thickened. 

" In two other persons, who died at a more advanced 
period of the disease, the stomach appeared spotted in many 
places with extravasations, and the inflammation disappear- 
ed. It contained, as did also the intestines, a black liquor, 
which had been vomited and purged before death. This 
black liquor appears clearly to be an altered secretion from 
the liver ; for a fluid in all respects of the same quality was 
found in the gall bladder. This liquor was so acrid, that 
it induced considerable inflammation and swelling on the 



BILIOUS YELLOW FEVER OF 1793. 93 

operator's hands, which remained some days. The villous 
membrane of the intestines, in these last two bodies, was 
found inflamed in several places. 

" The liver was of its natural appearance, excepting in 
one of the last persons, on the surface of which a very few 
distended veins were seen : all the other abdominal viscera 
were of a healthy appearance. 

" The external surface of the stomach, as well as of the 
intestines, was quite free from inflammation ; the veins 
being distended with blood, which appeared through the 
transparent peritoneum, gave them a dark colour. 

" The stomach of those who died early in the disease 
was always contracted ; but in those who died at a more 
advanced period of it, where extravasations appeared, it was 
distended with air. 

" P. S. PHYSICK, 
" J. CATHRALL.' , 

I have before remarked, that these dissections were made 
early in the disease, and that Dr. Annan attended a dissec- 
tion of a body at Bush-hill, some time afterwards, in which 
an unusual turgescence appeared in the vessels of the brain. 

Thus far have I delivered the history of the yellow fever, 
as it affected the human body with sickness and death. I 
shall now mention a few of those circumstances of public 
and private distress which attended it. I have before re- 
marked, that the first reports of the existence of this fever 
were treated with neglect or contempt. A strange apathy 
pervaded all classes of people. While I bore my share of 
reproach for " terrifying our citizens with imaginary dan- 
ger," I answered it by lamenting " that they were not terri- 
fied enough." The publication from the college of physi- 
cians soon dissipated this indifference and incredulity. Fear 
or terror now sat upon every countenance. The disease 
appeared in many parts of the town, remote from the spot 
where it originated ; although, for a while, in every instance, 
it was easily traced to it. This set the city in motion. The 
streets and roads leading from the city were crowded with 
families flying in every direction for safety to the country. 
Business began to languish. Water- street, between Market 
and Race-streets, became a desart. The poor were the first 
victims of the fever. From the sudden inturruption of 



94 AN ACCOUNT OF THE 

business they suffered for a while from poverty as well as 
from disease. A large and airy house at Bush-hill, about 
a mile from the city was opened for their reception. This 
house, after it became the charge of a committee appointed 
by the citizens on the 14th of September, was regulated 
and governed with the order and cleanliness of an old and 
established hospital. An American and French physician 
had the exclusive medical care of it after the 22d of Sep. 
tember. 

The disease, after the second week in September, spared 
no rank of citizens. Whole families were confined by it. 
There was a deficiency of nurses for the sick, and many of 
those who were employed were unqualified for their busi- 
ness. There was likewise a great deficiency of physicians, 
from the dissertion of some, and the sickness and death of 
others. At one time there were but three physicians who 
were able to do business out of their houses, and at this 
time there were probably not less than 6000 persons ill 
with the fever. 

During the first three or four weeks of the prevalence of 
the disease I seldom went into a house the first time with- 
out meeting the parents or children of the sick in tears. 
Many wept aloud in my entry or parlour, who came to ask 
for advice for their relations. Grief after a while descended 
below weeping, and I was much struck in observing that 
many persons submitted to the loss of relations and friends 
without shedding a tear, or manifesting any other of the 
common signs of grief. 

A cheerful countenance was scarcely to be seen in the 
city for six weeks. I recollect once, in entering the house 
of a poor man, to have met a child of two years old that 
smiled in my face. I was strangely affected with this sight 
(so discordant to my feelings and the state of the city) 
before I recollected the age and ignorance of the child. " I 
was confined the next day by an attack of the fever, and 
was sorry to hear, upon my recovery, that the father and 
mother of this little creature died a few days after my last 
visit to them. 

The streets every where discovered marks of the distress 
that pervaded the city. More than one half the houses were 
shut up, although not more than one third of the inhabitants 
had fled into the country. In walking for many hundred 



BILIOUS YELLOW FEVER OF 1793. 95 

yards, few persons were met, except such as were in quest 
of a physician, a nurse, a bleeder, or the men who buried 
the dead. The hearse alone kept up the remembrance of 
the noise of carriages or carts in the streets. Funeral pro- 
cessions were laid aside. A black man, leading or driving 
a horse, with a corpse on a pair of chair wheels, with now 
and then half a dozen relations or friends following at a 
distance from it, met the eye in most of the streets of the 
city, at every hour of the day, while the noise of the same 
wheels passing slowly over the pavements, kept alive an- 
guish and fear in the sick and well, every hour of the 
night.* 

But a more serious source of the distress of the city 
arose from the dissentions of the physicians, about the 
nature and treatment of the fever. It was considered by 
some as a modification of the influenza, and by others as 
the jail fever. Its various grades and symptoms were consi- 
dered as so many different diseases, all originating from 
different causes. There was the same contrariety in the 
practice of the physicians that there was in their principles. 
The newspapers conveyed accounts of both to the public, 
every day. The minds of the citizens were distracted by 
them, and hundreds suffered and died from the delays 
which were produced by an erroneous opinion of a plurality 
of diseases in the city, or by indecision in the choice, or a 
want of confidence in the remedies of their physician. 

The science of medicine is related to every thing, and 
the philosopher as well as the Christian will be gratified by 
knowing the effects of a great and mortal epidemic upon 
the morals of a people. It was some alleviation of the 

* In the Life of Thomas Story, a celebrated preacher among the friends, 
there is an account of the distress of the city, in its infant state, from die 
prevalence of die yellow fever, in the autiimn of 1699, nearly like that 
which has been described. I shall insert the account in his own words. 
" Great was tin fear that fell on all flesh. I saw no lofty or airy counte- 
Oance, nor h ard any vain jesting to move men to laughter. Eveiy face 
gathered paleness, and many hearts were humbled, and countenances 
fallen and sunk, as such that waited every moment to be summoned to 
the bar, and numbered to the grave." The same author adds, that six, 
seven, and sometimes ei^ht, died of this fever in a day, for several weeks. 
His fellow traveller, and companion in the ministry, Roger Gill, discover- 
ed upon this occasion an extraordinary degree of Christian philanthropy. 
He publickly offered himself, in one of the meetings of the society, as a 
sacrifice for the people, and prayed that " Ciod would please to accept of 
his life for them, that a stop might be put to the contagion." He died of 
the fever a few days afterwards. 



96 AN ACCOUNT OF THE 

distress produced bv it, to observe its influence upon the 
obligations of morality and religion. It was remarked 
during this time, by many people, that the name of the 
Supreme Being was seldom profaned, either in the streets, 
or in the intercourse of the citizens with each other. But 
two robberies, and those of a trifling nature, occurred in 
nearly two months, although many hundred houses were 
exposed to plunder, every hour of the day and night. 
Many of the religious societies met two or three times a 
week, and some of them every evening, to implore the 
interposition of Heaven to save the city from desolation. 
Humanity and charity kept pace with devotion. The pub- 
lic have already seen accounts of their benevolent exercises 
in other publications. It was my lot to witness the un- 
common activity of those virtues upon a smaller scale. I 
saw little to blame, but much to admire and praise in per- 
sons of different professions, both sexes, and of all colours. 
It would be foreign to the design of this work to draw 
from the obscurity which they sought, the many acts of hu- 
manity and charity, of fortitude, patience, and perseverance, 
which came under my notice. They will be made public 
and applauded elsewhere. 

But the virtues which were excited by our calamity were 
not confined to the city ol Philadelphia. The United States 
wept for the distresses of their capital. In several of the 
states, and in many cities and villages, days of humiliation 
and prayer were set apart to supplicate the Father of Mer- 
cies in behalf of our afflicted city. Nor was this all. From 
nearly every state in the union the most liberal contributions 
of money, provisions, and fuel were poured in for the 
relief and support of such as had been reduced to want 
by the suspension of business, as well as by sickness and 
the death of friends. 

The number of deaths between the 1st of August and 
the 9th of November amounted to four thousand and forty- 
four. I shall here insert a register of the number which 
occurred on each day, beginning on the 1st of August, and 
ending on the 9th of November. By comparing it with 
the register of the weather it will show the influence of the 
latter on the disease. Several of the deaths in August 
were from other acute diseases, and a few in the succeeding 
months were from such as were of a chronic nature. 



BILIOUS YELLOW FEVER OF 1793. 



9^ 



August 



September 



1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

29 

30 

31 

1 

2 

3 

4 

5 

6 

7 



died. 



9 

10 

10 

3 

12 

5 

11 

6 

7 

5 

11 

4 

9 

7 

6 

5 

9 

7 

8 

13 

10 

17 

12 

17 

12 

22 

24 

20 

17 

17 

18 

11 

23 

20 

24 

18 

456 





died. 


Brought forward 


456 


September 8 


42 


9 


32 


10 


29 


11 


23 


12 


33 


13 


37 


14 


48 


15 


56 


16 


67 


17 


81 


18 


68 


19 


61 


20 


67 


21 


57 


22 


76 


23 


68 


24 


96 


25 


87 


26 


52 


27 


60 


28 


51 


29 


57 


30 


63 


October 1 


74 


2 


66 


3 


78 


4 


58 


5 


71 


6 


76 


7 


82 


8 


90 


9 


102 


10 


93 


11 


119 


12 


111 


13 


104 


14 


81 



2972 



VOL. III. 



98 



AN ACCOUNT OF THE 





died. 








died. 


Brought forward 


2972 


Brought forward 




3685 


October 15 


80 


October 




28 


24 


16 


70 






29 


17 


17 


80 






30 


16 


18 


59 






31 


21 


19 


65 


November 




1 


13 


20 


55 






2 


21 


21 


59 






3 


15 


22 


82 






4 


15 


23 


54 






5 


14 


24 


38 






6 


11 


25 


35 


■*. s 




7 


15 


26 


23 






8 


8 


27 


13 






9 


6 




3685 




Total* 3881 



From this table it appears that the principal mortality 
was in the second week of October. A general expecta- 
tion had obtained, that cold weather was as fatal to this 
fever as heavy rains. The usual time for its arrival had 
come, but the weather was still not only moderate, but 
warm. In this awful situation, the stoutest hearts began 
to fail. Hope sickened, and despair succeeded distress in 
almost every countenance. On the fifteenth of October, 
it pleased God to alter the state of the air. The clouds 
at last dropped health in showers of rain, which continued 
during the whole day, and which were succeeded for seve- 
ral nights afterwards by cold and frost. The effects of this 
change in the weather appeared first in the sudden diminu- 
tion of the sick, for the deaths continued for a week after- 
wards to be numerous, but they were of persons who had 
been confined before, or on the day in which the change 
bad taken place in the weather. 

The appearance of this rain was like a dove with an 
olive branch in its mouth to the whole city. Public notice 
was given of its beneficial effects, in a letter subscribed by 
the mayor of Philadelphia, who acted as president of the 

* In the above accounts there is a deficiency of returns from several 
grave-yards of 163. 



BILIOUS YELLOW FEVER OP 1793. 99 

committee, to the mayor of New- York. I shall insert the 
whole of this letter. It contains, besides the above infor- 
mation, a record of the liberality of the city to the dis- 
tressed inhabitants of Philadelphia. 

"Sir, 

" I am favoured with your letter of the 12th instant, 
which I have communicated to the committee for the relief 
of the poor and afflicted of this city. 

" It is with peculiar satisfaction that I execute their re- 
quest, by making in their name, on behalf of our suffering 
fellow-citizens, the most grateful acknowledgments for the 
seasonable benevolence of the common council of the city 
of New- York. Their sympathy is balm to our wounds. 

" We acknowledge the Divine interposition, whereby 
the hearts of so many around us have been touched with 
our distress, and have united in our relief. 

" May the Almighty Disposer of all events be graciously 
pleased to protect your citizens from the dreadful calamity 
with which we are now visited ; whilst we humbly kiss the 
rod, and improve by the dispensation. 

11 The part, sir, which you personally take in our 
afflictions, and which you have so pathetically expressed in 
your letter, excites in the breasts of the committee the 
warmest sensations of fraternal affection. 

" The refreshing rain which fell the day before yesterday, 
though light, and the cool weather which hath succeeded, 
appear to have given a check to the prevalence of the dis- 
order : of this we have satisfactory proofs, as well in the 
decrease of the funerals, as in the applications for removal 
to the hospital. 

" I have, at your request, this day drawn upon you, at 
sight, in favour of the president and directors of the Bank 
of North America, for the sum of five thousand dollars, 
the benevolent donations of the common council of the 
city of New- York. 

" With sentiments of the greatest esteem and regard, 
" I am, sir, 
" Your most obedient humble servant, 
MATTH. CLARKSON. 

"Philadelphia, Oct. 17, 1793. 
" Richard V.vrick, mayor of the city of New- York." 1 



100 AN ACCOUNT OF THE 

It is no new thing for bilious fevers, of every description 
to be checked or subdued by wet and cold weather. 

The yellow fever which raged in Philadelphia in 1699, 
and which is taken notice of by Thomas Story in his 
journal, ceased about the latter end of October, or the be- 
ginning of November. Of this there are satisfactory 
proofs, in the register of the interments in the friends' 
burying-ground, and in a letter dated November 9th, old 
style, 1699, from Isaac Norris to one of his correspondents, 
which his grandson, Mr. Joseph P. Norris, politely put 
into my hands, with several others, which mention the dis- 
ease, and all written in that memorable year in Philadelphia. 
The Letter says, " It has pleased God to put a stop to our 
sore visitation, and town and country are now generally 
healthy." The same disease was checked by wet and cold 
weather in the year 1741. Of this there is a proof in a 
letter from Dr. Franklin to one of his brothers, who stopped 
at Burlington, on his way from Boston to Philadelphia, on 
account of the fever, until he was assured by the Doctor, 
that a thunder gust, which had cooled the air, had rendered 
it safe for him to come into the city.* Mr. Lynford 
Lardner, in a letter to one of his English friends, dated 
September 24, 1747, old style, after mentioning the preva- 
lence of the fever, in the city, says, " the weather is now 
much cooler, and those under the disorder revive. The 
symptoms are less violent, and the fever gradually abates." 

I have in vain attempted to procure an account of the 
time of the commencement of cold weather in the autumn 
of 1762. In the short history of the fever of that year, 
which I have inserted from my note book, I have said* that 
it continued to prevail in the months of November and De- 
cember. The register of the interments in the friends' bury- 
ing-ground in those months confirms that account. They 
Avere nearly as numerous in November and December as 
in September and October, viz. in September 22, in 
October 27, in November 19, and in December 26. 

* From a short note in the register of the interments in the friends' 
burjing-ground, it appears that the fever this year made its h>st appear- 
ance u, the month of ^ Jnne 1 he following is a copy of that note : « 12th 

!,rh » n "IT!/? S) f 41 ' a r'iS nant >' eli " w &«*■ now spreads 
m S \ SSfS, ^ 'w 2 tlK ; filw "ng: " 2 5th of the 7th month 

(O. b .), 1741, many who died of the above distemper were persons lively, 
and strong, and in the prime ot their time." V } 



BILIOUS YELLOW FEVER OF 1793. 101 

The bilious remitting fever of 1780 yielded to cool 
weather, accompanied by rain and an easterly wind. 

Sir John Pringle will furnish ample satisfaction to such 
of my readers as wish for more proofs of the efficacy of 
heavy rains, and cold weather, in checking the progress and 
violence of autumnal remitting fevers.* 

From the 15th of October the disease not only declined, 
but assumed more obvious inflammatory symptoms. It 
was, as in the beginning, more necessarily fatal where left 
to itself, but it yielded more certainly to art than it did a 
few weeks before. The duration of it was now more tedi- 
ous than in the warm weather. 

There were a few cases of yellow fever in November and 
December, after the citizens who had retired to the country 
returned to the city. 

I heard of but three persons who returned to the city 
being infected with the disease ; so completely was its cause 
destroyed in the course of a few weeks. 

In consequence of a proclamation by the governor, and 
a recommendation by the clergy of Philadelphia, the 12th 
of December was observed as a day of thanksgiving 
throughout the state, for the extinction of the disease in 
the city. 

It was easy to distinguish, in walking the streets, the 
persons who had returned from the country to the city, 
from those who had remained in it during the prevalence 
of the fever. The former appeared ruddy and healthy, 
while the latter appeared of a pale sallow colour. 

It afforded a subject of equal surprise and joy to behold 
the suddenness with which the city recovered its former 
•habits of business. In the course of six weeks after the 
disease had ceased, nothing but fresh graves, and the black 
dresses of many of the citizens, afforded a public trace of 
the distress which had so lately prevailed in the city. 

The month of November, and all the winter months 
which followed the autumnal epidemic, were in general 
healthy. A catarrh affected a number of people in Novem- 
ber. I suspected it to be the influenza which had revived 
from a dormant state, and which had not spent itself, when 
it yielded to the predominance of the yellow fever. This 
opinion derives some support from a curious fact related by 

* p. 5,56, 108, and 323. 



102 AN" ACCOUNT OF THE 

the late Mr. Hunter of the revival of the small-pox in a 
patient, in whom it had been suspended for some time by 
the measles.* The few fevers which prevailed in the winter 
were highly inflammatory. The small-pox in the natural 
way was in several instances confluent ; and in one or two 
fatal. I was prepared to expect this inflammatory diathesis 
in the fevers of the winter ; for I had been taught by Dr. 
Sydenham, that the diseases which follow a great and 
mortal epidemic partake more or less of its general charac- 
ter. But the diseases of the winter had a peculiarity still 
more extraordinary ; and that was, many of them had seve- 
ral of the symptoms of the yellow fever, particularly a puk- 
ing of bile, dark-coloured stools, and a yellow eye. Mr. 
Samuel D. Alexander, a student of medicine from South- 
Carolina, who was seized with a pneumony about Christ- 
mas, had, with a yellow eye, a dilated pupil and a hard 
pulse, which beat only fifty strokes in a minute. His blood 
was such as I had frequently observed in the yellow fever. 
Dr. Griffits informed me that he attended a patient on the 
9th of January, in a pneumony, who had a universal yel- 
lowness on his skin. I met with a case of pneumony on 
the 20th of the same month, in which I observed the same 
degrees of redness in the eyes that were common in the 
yellow fever. My pupil, Mr. Coxe, lost blood in an in- 
flammatory fever, on the 18th of February, which was 
dissolved. Mr. Innes, the brewer, had a deep yellow colour 
in his eyes, on the fourth day of a pneumony, on the 27th 
of the same month ; and Mr. Magnus Miller had the same 
symptom of a similar disease on the 16th of March. None 
of these bilious and anomalous symptoms of the inflamma- 
tory fevers of the winter and spring surprised me. 1 had' 
been early taught by Dr. Sydenham that the epidemics of 
autumn often insinuate some of their symptoms into the 
winter diseases which follow them. Dr. Cleghorn informs 
us, that " the pleurisies which succeeded the autumnal ter- 
tians in Minorca, were accompanied by a vomiting and 
purging of green or yellow bilious matters, "f 

It belongs to powerful epidemics to be followed by simi- 
lar diseases after they disappear, as well as to run into 
others at their first appearance. In the former case it is 

* Introduction to a Treatise on the Venereal Disease, p. 3 of the Ame- 
rican edition. | Page 273. ' 



BILIOUS YELLOW FEVER OF 1793. 103 

occasioned by a peculiar state of the body, created by the 
epidemic constitution of the air, not having been changed 
by the weather which succeeded it. 

The weather in March resembled that of May ; while 
the weather in April resembled that of March in common 
years. A rash prevailed in many families, in April, ac- 
companied in a few cases by a sore throat. It was attended 
with an itching, a redness of the eyes, and a slight fever in 
a few instances. The small-pox by inoculation in this 
month was more mortal than in former years. However 
unimportant these facts may appear at this time, future 
observations may perhaps connect them with a similar con- 
stitution of the air which produced the previous autumnal 
epidemic. 

The appearance of bilious symptoms in the diseases of 
the winter, excited apprehensions in several instances of the 
revival of the yellow fever. The alarms, though false, 
served to produce vigilance and industry in the corporation, 
in airing and purifying such houses and articles of furni- 
ture as belonged to the poor ; and which had been neglect- 
ed in the autumn, after the ceasing of the disease. 

The modes of purif) ing houses, bed--, and clothes were 
various. Fumigations of nitre and aromatic substances 
were used by some people. Burying infected articles of 
furniture under ground, and baking them in ovens, were 
used by others. Some destroyed all their beds and clothing 
that had been infected, or threw them into the Delaware. 
Many white-washed their walls, and painted the wood-work 
of their house. I did not conceive the seeds of the disease 
required all, or any of those means to destroy it. I believed 
cold and water to be sufficient for that purpose. I therefore 
advised keeping the windows of infected rooms open night 
and day, for a few days; to have the floors and walls of houses 
well washed; and to expose beds and such articles of 
household furniture as might be injured by washing, upon 
the bare earth for a week or two, taking care to turn them 
every day. I used no other methods of destroying the ac- 
cumulated miasmata in my house and furniture, and expe- 
rience showed that they were sufficient. 

It is possible a portion of the excretions of the sick may 
be retained in clothes or beds, so as to afford an exhalation 
that may in the course of a succeeding summer and autumn, 



104 AN ACCOUNT OF THE 

or from accidental warmth at any time, create a solitary 
case of fever, but it cannot render it epidemic. A trunk 
full of clothes, the property of Mr. James Bingham, who 
died of the yellow fever in one of the West-India islands 
about 50 years ago, were opened, some months after they 
were received by his friends, by a young man who lived in 
his brother's family. This young man took the disease, 
and died; but without infecting any of the family; nor did the 
disease spread afterwards in the city. The father of Mr. 
Joseph Paschall was infected with the yellow fever of 1741, 
by the smell of a foul bed in passing through Norris's Alley, 
in the latter end of December, after the disease had left the 
city. He died on the 25th of the month, but without reviv- 
ing the fever in the city, or even infecting his family. 

The matter which produced the fever in both these cases, 
had nothing specific in it. It acted in the same manner that 
the exhalation from any other putrid matters would have 
done in a highly concentrated state. 

In a letter from Dr. Senter of Newport, dated January 
7th, 1794, I find the following fact, which I shall commu- 
nicate in his own words. It is introduced to support the 
principle, that the yellow fever does not spread by conta- 
gion. " This place (says the doctor) has traded formerly 
very much to the West-India islands, and more or less 
of our people have died there every season, when the dis- 
ease prevails in those parts. Clothes of these unfortunate 
people have been repeatedly brought home to their friends, 
without any accident happening to them." 

I feel with my reader the fatigue of this long detail of 
facts, and equal impatience with him to proceed to the his- 
tory of the treatment of the fever ; but I must beg leave to 
detain him a little longer from that part of the work, while 
I resume the subject of the origin of the fever. It is an 
interesting question, as it involves in it the means of prevent- 
ing the return of the disease, and thereby of saving the lives 
of thousands of our citizens. 

Soon after the fever left the city, the governor of the state 
addressed a letter to the college of physicians, requesting to 
know their opinion of its origin ; if imported, from what 
place, at what time, and in what manner. The design of 
this inquiry was to procure such information as was proper 
to lay before the legislature, in order to improve the laws 



BILIOUS YELLOW FEVER OF 1793. 105* 

for preventing the importation or generation of infectious 
diseases, or to enact new ones, if necessary for that purpose. 
To the governor's letter the college of physicians sent the 
following answer : 

"Sir, 

" It has not been from a want of respect to your- 
self, nor from inattention to the subject, that your letter of 
the 30th ult. was not sooner answered ; but the importance 
of the questions proposed has made it necessary for us to 
devote a considerable portion of time and attention to the 
subject, in order to arrive at a safe and just conclusion. 

" No instance has ever occurred of the disease called the 
yellow fever having been generated in this city, or in any 
other parts of the United States, ^s for as we know ; but 
there have been frequent instances of its having been im- 
ported, not only into this, but into other parts of North- 
America, and prevailing there for a certain period of time ; 
and from the rise, progress, and nature of the malignant fever, 
which began to prevail here about the beginning of last 
August, and extended itself gradually over a great part of 
the city, we are of opinion that this disease was imported 
into Philadelphia, by some of the vessels which arrived in 
the port after the middle of July. This opinion we are fur- 
ther confirmed in by various accounts we have received 
from unquestionable authorities. 

" Signed, by order of the college of physicians 

« JOHN REDMAxN, President. 

M November 26t/i, 1793. 

" To the governor of Pennsylvania." 

Dr. Redman, the president of the college, Dr. Foulke, 
and Dr. Leib, dissented from the report contained in this 
letter. I have been necessarily led to continue it in the 
present edition of this work, not only because all the other 
members of that body still retain their belief of the impor- 
tation of the fever, but as a reason for republishing the facts 
and arguments in support of its domestic origin. 

I have asserted, in the introduction to the history of this 

VOL. III. O 



106 AN ACCOUNT OF THE 

fever, that I believed it to have been generated in our city; 
I shall now deliver my reasons for that belief. 

1. The yellow fever in the West-Indies, and in all other 
countries where it is endemic, is the offspring of vegetable 
putrefaction. Heat, exercise, and intemperance in drinking 
(says Dr. Lind) dispose to this fever in hot climates, but 
they do not produce it without the concurrence of a remote 
cause. This remote cause exists at all times, in some spots 
of the islands, but in other p.rts even of the same islands, 
where there are no marsii exhalations, the disease is un- 
known. I shajl not waste a moment in enquiring into the 
truth of Dr. Warren's account of the origin of this fever. 
It is fully refuted by Dr. Hillary, and it is treated as chime- 
rical by Dr. Lind. They have very limited ideas of the 
history of this fever who suppose it to be peculiar to the 
East or West-Indies. It was admitted to have been gene- 
rated in Cadiz after a hot and dry summer in 1764, and in 
Pensacola in 1765.* The tertain fever of Minorca, when 
it attacked Englishmen, put on the usual symptoms of the 
yellow fever.f In short, this disease appears, according to 
Dr. Lind, in all the southern parts of Europe, after hot and 
dry weather .| 

2. The same causes (under like circumstances) must 
always produce the same effects. There is nothing in the 
air of the West- Indies, above other hot countries, which 
disposes it to produce a yellow fever. Similar degrees of 
heat, acting upon dead and moist vegetable matters, are 
capable of producing it, together with all its various modi- 
fications, in every part of the world. In support of this 
opinion, I shall transcribe part of a letter from Dr. Miller, 
formerly of the Delaware state, and now of New- York. 

" Dover, Nov. 5, 1793. 
" Dear Sir, 

" SINCE the middle of last July we have 
had a bilious colic epidemic in this neighbourhood, which 
exhibits phamomina very singular in this climate ; and, so 
far as I am informed, unprecedented in the medical records, 
or popular traditions of this country. To avoid unneces- 
sary details it will suffice at present to observe, that the 

* Lind on the Diseases of Hot Climates, p. 36 and 124. 

t Cleghorn, p. 176. £ Diseases of Hot Climates, p. 123. 



BILIOUS YELLOW FEVER OF 1793. 107 

disease, on this occasion, has assumed, not only all the 
essential characters, but likewise all the violence, obstinacy, 
and malignity described by the East and West Indian 
practitioners. If any difference can be observed it seems 
here to manifest higher degrees of stubbornness and ma- 
lignity than we usually meet in the histories of tropical wri- 
ters. In the course of the disease, not only extreme consti- 
pation, frequent vomiting, and the most excruciating pains 
of the bowels and limbs, harass the unhappy patient ; but 
to these succeeded paralysis, convulsions, &c. and almost 
always uncommon muscular debility, oppression of the 
prascordia, &c. are the consequence of a severe attack. 
Bile discharged in enormous quantities constantly assumes 
the most corrupted and acrimonious appearances, com- 
monly aeruginous in a very high degree, and sometimes 
quite atrabilious. 

" The inference I mean to draw from the phenomena of 
this disease, as it appears in this neighbourhood, and which 
I presume will also apply to your epidemic, is this, that 
from the uncommon protraction and intenseness of our 
summer and autumnal heats, but principally from the un- 
usual drought, we have had, since the middle of July, a 
near approach to a tropical season, and that of consequence 
we ought not to be surprized if tropical diseases, even of 
the most malignant nature, are engendered amongst us." 

To the above information it may be added, that the 
dysentery which prevailed during the autumn of 1793, in 
several of the villages of Pennsylvania, was attended with 
a malignity and mortality unknown before in any part of 
the state. I need not pause to remark that this dysentery 
arose from putrid exhalation, and that it is, like the bilious 
colic, only a modification of bilious fever. 

But further, a malignant fever, resembling that which 
was epidemic in our city, prevailed during the autumn in 
many parts of the United States, viz. at Lynn in Massa- 
chusetts, at Weatherfk Id and Coventry in Connecticut, at 
New-Galloway in the state of New-York, on Walkill, and 
on Pensocken creeks in New-Jersey, at Harrisburgh and 
Hummelstown in Pennsylvania, in Caroline county in 
Maryland, on the south branch of the Potowmac in Hardie 
county, also in Lynchburgh and in Alexandria in Virginia, 
and in several counties in North-Carolina. In none of 



108 AN ACCOUNT OF THE 

these places was there a suspicion of the disease being 
imported from abroad, or conveyed by an intercourse with 
the city of Philadelphia. 

It is no objection to the inference which follows from 
these facts, that the common remitting fever was not known 
during the above period in the neighbourhood of this city, 
and in many other parts of the state, where it had usually 
appeared in the autumnal months. There is a certain com- 
bination of moisture with heat, which is essential to the 
production of the remote cause of a bilious fever. Where 
the heat is so intense, or of such long duration, as wholly 
to dissipate moisture, or when the rains are so great as to- 
tally to overflow the marshy ground, or to wash away 
putrid masses of matter, no fever can be produced. 

Dr. Dazilles, in his treatise upon the diseases of the ne- 
groes in the West- Indies, informs us, that the rainy season 
is the most healthy at Cayenne, owing to the neighbouring 
morasses being deeply overflowed ; whereas, at St. Domin- 
go, a dry season is most productive of diseases, owing to 
its favouring those degrees of moisture which produce 
morbid exhalations. These facts will explain the reason 
why, in certain seasons, places which are naturally healthy 
in our country become sickly, while those places which are 
naturally sickly escape the prevailing epidemic. Previously 
to the dissipation of the moisture from the putrid masses 
of vegetable matters in other streets, and in the neighbour- 
hood of the city, there were (as several practitioners can 
testify) many cases of mild remittents, but they all disap- 
peared about the first week in September. 

It is worthy of notice, that the yellow fever prevailed in 
Virginia in the year 1741, and in Charleston, in South- 
Carolina, in the year 16->9, in both which years it prevailed 
in Philadelphia. Its prevalence in Charleston is taken 
notice of in a letter, dated November 18th, O. S. 1699, 
from Isaac Norris to one of his correspondents. The letter 
says that " 150 persons had died in Charleston in a few 
days," that " the survivors fled into the country," and that 
" the town was thinned to a very few people." It is not 
probable, from the prevalence of this fever twice in two 
places in the same years, that it was produced (as in 1793) 
by a general constitution of air, co-operating with mias- 
mata, which favoured its generation in different parts of the 



BILIOUS YELLOW FEVER OF 1793. 109 

continent ? But again, such was the state of the air, in the 
summer of 1793, that it predisposed other animals to dis- 
eases, besides the human species. In some parts of New- 
Jersey, a disease prevailed with great mortality among the 
horses, and in Virginia among the cows, during the autumn. 
The urine in both was yellow. — Large abscesses appeared 
in different parts of the body in the latter animals, which, 
when opened, discharged a yellow serous fluid. From 
the colour of these discharges, and of the urine, the disease 
got the name of the yellonv water. 

3. I have before remarked, that a quantity of damaged 
coffee was exposed at a time (July, the 24th) and in a sit- 
uation (on a wharf and in a dock) which favoured its pu- 
trefaction and exhalation. Its smell was highly putrid and 
offensive, insomuch that the inhabitants of the houses in 
Water and Front- streets, who were near it, were obliged, 
in the hottest weather, to exclude it by shutting their doors 
and windows. Even persons, who only walked along those 
streets, complained of an intolerable fcetor, which upon in- 
quiring, was constantly traced to the putrid coffee. It should 
not surprise us, that this seed, so inoffensive in its natural 
state, should produce, after its putrefaction, a violent fever. 
The records of medicine (to be mentioned hereafter) fur- 
nish instances of similar fevers being produced by the 
putrefaction of many other vegetable substances. 

4. The rapid progress of the fever from Water-street, 
and the courses through which it travelled into other parts of 
the city, afford a strong evidence that it was at first propa- 
gated by exhalation from the putrid coffee. It was obser- 
ved that it passed first through those alleys and streets 
which were in the course of the winds that blew across the 
dock and wharf, where the coffee had been thrown in a 
state of putrefaction. 

5. Many persons who had worked, or even visited, in 
the neighbourhood of the exhalation from the coffee, early 
in the month of August, were indisposed afterwards with 
sickness, puking, and yellow sweats, long before the air of 
Water- street was so much impregnated with the exhalation, 
as to produce such effects ; and several patients, whom I 
attended in the yellow fever, declared to me, or to their 
friends, that their indispositions began exactly at the time 
they inhaled the offensive effluvia of the coffee. 



110 AN ACCOUNT OF THE 

6. The first cases of the yellow fever have been clearly 
traced to the sailors of the vessel who were first exposed to 
the effluvia of the coffee. Their sickness commenced 
with the day on which the coffee began to emit its putrid 
smell. The disease spread with the increase of the poison, 
ous exhaltion. A journeyman of Mr. Peter Brown, who 
worked near the corner of Race and Water-streets, caught 
the disease on the 27th of July. Elizabeth Hill, the wife 
of a fisherman, was infected by only sailing near the pesti- 
lential wharf, about the 1st of August, and died at Ken- 
sington on the 14th of the same month. Many other 
names might be mentioned of persons who sickened dur- 
ing the last week in July or the first week in August, who 
ascribed their illness to the smell of the coffee. 

7. It has been remarked that this fever did not spread in 
the country, when carried there by persons who were in- 
fected, and who afterwards died with it. During four 
times in which it prevailed in Charleston, in no one instance, 
according to Dr. Lining, was it propagated in any other 
part of the state. 

8. In the histories of the disease which have been pre- 
served in this country, it has six times appeared about the 
first or middle of August, and declined or ceased about 
the middle of October: viz. in 1732, 1739, 1745, and 
1748 in Charleston, in 1791 in New-York, and in 1793 in 
Philadelphia. This frequent occurrence of the yellow 
fever at the usual period of our common bilious remittens, 
cannot be ascribed to accidental coincidence, but must be 
resolved, in most cases, into the combination of more active 
miasmata with the predisposition of a tropical season. In 
speaking of a tropical season, I include that kind of wea- 
ther in which rains and heats are alternated with each other, 
as well as that which is uniformly warm. 

9. Several circumstances attended this epidemic, which 
do not occur in the West-India yellow fever. It affected 
children as well as adults, in common with our annual 
bilious fevers. In the West-Indies, Dr. Hume tells us, it 
never attacked any person under puberty. It had, more- 
over, many peculiar symptoms (as I have already shown) 
which are not to be met with in any of the histories of the 
West- India yellow fever. 

10. Why should it surprise us to see a yellow fever 



BILIOUS YELLOW FEVER OF 1793. Ill 

generated amongst us ? It is only a higher grade of a fever 
which prevails every year in our city, from vegetable pu- 
trefaction. It conforms, in the difference of its degrees of 
violence and danger to season as well as climate, and in this 
respect it is upon a footing with the small-pox, the measles, 
the sore-throat, and several other diseases. There are few 
years pass, in which a plethoric habit, and more active but 
limited miasmata, do not produce sporadic cases of true 
yellow fever in Philadelphia. It is very common in South 
and North-Carolina and in Virginia, and there are facts 
which prove, that not only strangers, but native individuals, 
and in one instance, a whole family, have been carried off 
by it in the state of Maryland. It proved fatal to one hun- 
dred persons in the city of New- York in the year of 1791, 
where it was evidently generated by putrid exhalation. 
The yellow colour of the skin has unfortunately too often 
been considered as the characteristic mark of this fever, 
otherwise many other instances of its prevalence might be 
discovered, I have no doubt, in every part of the United 
States. I wish, with Dr. Mosely, the term yellow could 
be abolished from the titles of this fever, for this colour is 
not only frequently absent, but sometimes occurs in the 
mildest bilious remittents. Dr. Haller, in his pathology, 
describes an epidemic of this kind in Switzerland, 
in which this colour generally attended, and I have once 
seen it almost universal in a common bilious fever, which 
prevailed in the American army, in the year 1776. 

I cannot help taking notice, in this place, of an omission 
in the answer to the governor's letter, by the college of 
physicians. The governor requested to know whether it 
was imported ; if it were, from what place, at what time, 
and in what manner. In the answer of the college of phy- 
sicians to the governor's letter no notice was taken of any 
of those questions. In vain did Dr. Foulke call upon the 
college to be more definite in their answer to them. They 
had faithfully sought for the information required, but to no 
purpose. The character of their departed brother, Dr. 
Hutchinson, for capacity and vigilance in his office, as in- 
spector of sickly vessels, was urged without effect as an 
argument against the probability of the disease being im- 
ported. Public report had derived it from several different 
islands ; had chased it from ship to ship, and from shore to 



112 AN ACCOUNT OF THE 

shore, and finally conveyed it at different times into the city, 
alternately by dead and living bodies ; and from these tales, 
all of which when investigated, were proved to be without 
foundation, the college of physicians composed their letter. 
It Mould seem, from this conduct of the college, as if me- 
dical superstition had changed its names, and that, in ac- 
counting for the origin of pestilential fevers, celestial, plan- 
etary, and demoniacal influence had only yielded to the 
term importation. 

Let not the reader reject the opinion I have delivered 
because it is opposed by so great a majority of the physi- 
cians of Philadelphia. A single physician supported an 
opinion of the existence of the plague at Messina, in the 
year 1743, in opposition to all the physicians (33 in num- 
ber) of that city. They denied the disease in question to 
exist, because it was not accompanied by glandular swell- 
ings. Time showed that they were all mistaken, and the 
plague, which might probably have been checked, at its 
first appearance, by their united efforts, was, by means of 
their ignorance, introduced with great mortality into every 
part of the city. This disposition of physicians to limit the 
symptoms of several other diseases, cannot be sufficiently 
lamented. The frequent absence of a yellow colour in this 
epidemic, led to mistakes which cost the city of Philadel- 
phia several hundred lives. 

The letter of the college of physicians has served to con- 
firm me in opinion, that the plagues which occasionally 
desolated most of the countries of Europe, in former cen- 
turies, and which were always said to be of foreign extrac- 
tion, were of domestic origin. Between the years 1006 and 
1680, the plague was epidemic fifty-two times all over 
Europe. It prevailed fourteen times in the 14th century. 
The state of Europe in this long period is well known. 
Idleness, a deficiency of vegetable aliment, a camp life, 
from the frequency of wars, famine, an uncultivated and 
marshy soil, small cabins, and the want of cleanliness in 
dress, diet, and furniture, all concurred to generate pesti- 
lential diseases. The plagues which prevailed in London, 
every year from 1593 to 1611, and from 1636 to 1649, I 
believe were generated in that city. The diminution of 
plagues in Europe, more especially in London, appears to 
have been produced by the great change in the diet and 



BILIOUS YELLOW FEVER OF 1793. 113 

manners of the people ; also by the more commodious and 
airy forms of the houses of the poor, among whom the 
plague always makes its first appearance. It is true, these 
plagues, were said by authors to have been imported, either 
directly or indirectly, from the Levant ; but the proofs of 
such importation were as vague and deficient as they were 
of the West-India origin of our epidemic. The pestilential 
fevers which have been mentioned, have been described by 
authors by the generic name of the plague, but they appear 
to have originated from putrid vegetable exhalations, and 
to have resembled, in most of their symptoms, the West- 
India and North-American yellow fever. 

I shall resume this interesting subject in another place, 
in which I shall mention a number of additional facts, not 
only in support of the domestic origin of the bilious yellow 
fever, but of its not spreading by contagion, and of course 
of its being impossible to import it. I shall at the same 
time enumerate all its different sources, and point out the 
means of destroying or removing them, and thus of exter- 
minating the disease from our country. 

With these observations I conclude the history of the 
epidemic fever of the year 1793. A few of its symptoms 
which have been omitted in this history, will be included 
in the method of cure, for they were discovered or produ- 
ced by the remedies which were given for that purpose. 



VOL. III. 



£5* The following page begins an account of the states 
of the thermometer and weather, from the 1st of Janu- 
ary to the 1st of August, and of the states of the ba- 
rometer, thermometer, winds, and weather from the 
1st of August to the 9th of November, 1793!. 
The times of observation, for the first three months 
are at 7 in the morning, and 2 in the afternoon ; 
for the next five months they are at 6 in the morning, 
and 3 in the afternoon. From the 1st of October to 
the 9th of November, they are as in the first three 
months. 



THE BILIOUS YELLOW FEVER OF 1793. 117 



January y 1793. 



February, 1793. 



\>. 



I* he i 



7 
8 
9 
If) 
I I 
12 
13 
14 
15 
16 
17 
18 
ID 
20 
2, 
22 
23 
24 
25 
26 
27 
28 
29 
30 

31 



7li 2h 



Weather. 



30 Cloudy. 

41 Fair, cloudy. 
33 Cloudy, rain. 
4i Rain, cloudy. 

42 Fair, cloudy. 

47 Cloudy, fair. 

51 Fair, fair. 
49 Fair, ditto. 

48 Hazy, fair. 
5 I Fair, ditto. 

Fair, clouds. 
42 Fair, ditto. 
42 Fair, ditto. 
27 Hail, snow, sleet. 

37 Clouds, mist. 
39 Rain, ditto. 

45 Rain, snow, fair. 

52 Fair, ditto. 
48 Fair, ditto. 

47 Hazy, cloudy. 
47 Cloudy fair. 

2 Fair, ditto. 

7 Fair, ditto. 
39 Cloudy, ditto. 
41 Fair, hazy. 
— Fair, 

38 Fair, cloudy, snow 
45 Cloudy, fair. 

37 Fair, ditto. 
23 Snow, hail. 
52 Cloudy, fair. 



The i 



7h2h 



26 

34 

37 

4 6 

44 

46 

40 

4 4 

50 

41) 

27 

28 

31 

39 

40 

42 

48 

49 

41 

53 

49 

3 4 

34 

59 

35 

43 

43 

26 



Weather. 



Fair, hazy. 
Rain, ditto. 
Cloudy, fair. 
Lloudy, fair. 
Cloudy, ditto. 
Cloudy, rain. 
Cloudy, fair. 
Cloudy, ditto. 
Rain, fair. 
Cloudy, fair. 
Fair, cloudy. 
Snow, cloudy. 
Cloudy, snow. 
Cloudy, fair. 
Fair, ditto. 
Cloudy, ditto. 
Rain, ditto. 
Cloudy, fair. 
Cloudy, rain. 
Rain, fair. 
Fair, ditto. 
Fair, ditto. 
Snow, cloudy. 
Rain, cloudy. 
Cloudy, ditto. 
Rain, mist. 
Rain, cloudy. 
Fair, ditto. 



118 



AT* ACCOUNT OF THE 



March, 1793. 



April, 1793. 



1 


r.her 




Ther 






D. 

l 




Weather. 




Weather. 




7h 

20 


2ii 
38 


7h 

45 


21) 

70 




Fair, ditto. 


Cloudy, fair. 




2 


31 


51 


Hazy, cloudy. 


47 


7i 


Fair, ditto. 




3 


48 


63 


Rain, fair. 


5 6 


80 


Fair, ditto. 




4 


43 


61 


Hazy, ditto. 


51 


72 


Cloudy, fair. 




5 


51 


52 


Rain, fair. 


53 


61 


Cloudy, rain. 




6 


32 


50 


Fair, ditto. 


60 


76 


Misty, fair. 




7 


36 


62 


Fair, ditto, clouds. 


51 


65 


Fair, ditto. 




8 


54 


60 


Cloudy, rain. 


46 


74 


Fair, ditto. 




J 


26 


41 


Fair, ditto. 


55 


71 


Fair, cloudy. 




10 


29 


51 


Fair, ditto. 


50 


56 


Fair, ditto. 




11 


43 


55 


Rain, ditto. 


37 


63 


Fair, ditto. 




12 


40 


43 


Cloudy, ditto. 


54 


62 


Cloudy, rain, fair. 




13 


38 


39 


Cloudy, fair. 


49 


62 


Fair, ditto. 




14 


26 


44 


Fair, ditto. 


50 


70 


Fair, ditto. 




15 


32 


59 


Fair, ditto. 


45 


55 


Rain, cloudy. 




16 


52 


62 


Cloudy, fair. 


46 


62 


Cloudy, fair. 




17 


51 


72 


Cloudy, fair. 


48 


67 


Fair, clouds, fair. 




18 


58 


69 


Hazy, cloudy. 


52 


66 


Cloudy, fair. 




19 


5S 


59 


Fair, ditto. 


5 2 


75 


Fair, ditto. 




20 


42 


61 


Fair, ditto. 


52 


49 


Rain, cloudy. 




21 


41 


43 


Rain, cloudy. 


4,4 


47 


Cloudy, ditto. 




22 


31 


47 


Fair, ditto. 


43 


46 


Rain, cloudy. 




23 


35 


57 


Fair, ditto. 


42 


63 


Fair, ditto. 




24 


37 


50 


Fair, ditto. 


44 


68 


Fair, ditto. 




25 


35 


59 


Fair, ditto. 


45 


65 


Cloudy, ditto. 




26 


47 


5 4 


Cioudy, rain. 


53 


57 


Cioudy, rain. 




27 


43 


51 


Fair, cloudy. 


47 


46* 


Rain, ditto. 




28 


33 


45 


Fair, clouds, fair. 


44 


54 


Rain, cloudy. 




29 


3457 


Fair, ditto. 


40 


59 


Fair, ditto. 




30 


41 58 


Cloudy, fair. 


40 


65 


Fair, ditto. 




31 


42,61 


Cloudy, fair. 











BILIOUS YELLOW FEVER OF 1793. 



119 



May, 1793. 



June, 1793. 



Therl 




) 


7h 

45 


2h 

69 


Weather. 


7 


2h 


Weather 


Foggy, cloudy. 


53 61 


Rain, showery. 


3 


52 


73 


Fog, clouds, fair. 


5464 


Clouds, showers. 


3 


60 


63 


Rain, ditio. 


55 


62 


Cloudy, rain, fair. 


4 


60 


80 


Fair, ditto. 


54 


60 


Rain, do. cloudy. 


5 


55 


56 


Cloudy, ditto. 


58 


72 


Cloudy, fair, rain. 


6 


47 


58 


Cloudy, fair. 


— 


71 


Cloudy, rain, 


7 


50 


68 


Cloudy, fair. 


68 


78 


Fair, ditto. 


8 


59 


78 


Cloudy, fair. 


65 


— 


Fair, ditto. 


9 


61 


79 


l"'oggy> fair- 


70 


88 


Fog, fair. 


10 


65 


71 


Rain, hazy. 


74 


90 


Fair, ditto. 


11 


>5 


75 


Cloudy, fair. 


76 


90 


Fair, ditto. 


12 


61 


76 


Cloudy, rain. 


75 


88 


Fair, showers. 


13 


57 


78 


Fair, ditto. 


74 


81 


Cloudy, rain. 


14 


59 


83 


Fair, cloudy. 


63 


77 


Fair, ditto. 


15 


60 


71 


Fair, ditto. 


63 


82 


Fair, hazy. 


16 


50 


69 


Fair, ditto. 


67 


85 


Fair, ditto. 


17 


48 


74 


Fair, ditto. 


74 


89 


Fair, showers. 


18 


6i 


81 


Cloudy, fair. 


73 


88 


Fair, ditto. 


19 


65 


85 


Fair, rain. 


77 


91 


Fair, ditto. 


20 


65 


87 


Fair, ditto. 


79 


88 


Fair, rain, fair. 


21 


68 


86 


Fair, ditto, clouds. 


75 


85 


Cloudy, rain. 


22 


72 


80 


Clouds, gusts. 


58 


78 


Cloudy, fair. 


23 


94 


7 y 


Cloudy, fair. 


>8 


78 


Fair, ditto. 


24 


58 


75 


Fair, ditto. 


60 


79 


Fair, ditto. 


25 


52 


TO 


Fair, cloudy. 


67 


74 


Cloudy, rain. 


26 


61 


66 


Rain, ditto. 


66 


69 


Cloudy, rain. 


27 


SI 


84 


Cloudy, fair. 


68 


80 


Cloudy, fair. 


28 


70 


• >8 


Fair, clouds, rain. 


71 


8 5 


Cloudy, fair. 


29 


-7 


62 


Cloudy, rain, clouds 


77 


88 


Cloudy, ditto. 


30 


5 


57 


Ci udy, rain 


74 


90 


Fair, ditto. 


31 






C) •wis. r!i to 






_ 



120 



AN ACCOUNT OF THE 



JULY, 1793. 



1 




Barom. 




Ther . 


Winds. 


Weather. 


c/5 


i 




S 




& 


£ 


i 


2 




C3 


< 




(£ 




< 


h 


< 


jfc 




Q 


«c 


i 


co 




<£> 


CO 


<£> 


Ci 




1 


30 





29 


9 


77 


88 


W 


W 


Fair. 


2 


29 


8 


29 


7 


77 


81 


w 




Fair, showers. 


i 3 


22 


9 


30 





74 


80 


E 


E 


Cloudy. 


4 


30 


1 


30 





70 


83 


E 


SW 


Cloudy, fair, rain. 


5 


30 





29 


9 


76 


90 


NW 


SW 


Fair, ditto. 


6 


29 


9 


29 


9 


78 


91 


sw 


SW 


Cloudy, thunder. 


7 


29 


9 


30 





73 


88 


NE 


NW 


Fair, clouds. 


8 


30 


1 


30 


1 


72 


85 


E 


E 


Cloudy, fair. 


9 


30 





29 


8 


73 


81 


S 


SW 


Cloudy, ditto. 


10 


30 





30 





70 


84 


W 


NW 


Fair, ditto. 


1 1 


30 





30 





74 


88 


NW 


NW 


Fair, clouds. 


12 


30 


1 


30 


2 


70 


84 


N 


N 


Fair, ditto. 


1 3 


30 


1 


30 





68 


83 


NW 


NW 


Fair, ditto. 


14 


30 





30 





65 


80 


N 


Calm 


Fair, hazy. 


15 


30 





29 


9 


66 


75 


SW 


SW 


Cloudy, ditto. 


16 


29 


8 


29 


7 


70 


83 


w 


W 


Rain, fair. 


17 


29 


8 


29 


9 


68 


81 


NW 


NW 


Fair, ditto. 


18 


SO 





30 





66 


86 


w 


SW 


Fair, ditto. 


19 


29 


9 


29 


9 


75 


85 


sw 


w 


Fair, cloudy, rain. 


20 


30 





30 





72 


87 


w 


NW 


Fair, ditto, shower. 


21 


30 


1 


30 


1 


70 


86 


NW 


NW 


Fair, ditto. 


22 


30 





30 





72 


87 


sw 


SW 


Fair, ditto. 


23 


30 





30 





73 


91 


sw 


sw 


Fair, cloudy. 


24 


29 


9 


29 


9 


75 


89 


Calm 


w 


Cloudy, fair. 


25 


30 


I 


30 


1 


71 


83 


NW 


NNW 


Fair, ditto. 


26 


30 


2 


30 


2 


63 


82 


N 


NE 


Fair, ditto. 


27 


30 


2 


30 


1 


64 


81 


S Calm 


S 


Fair, cloudy. 


28 


30 


1 


30 





72 


85 


Calm 


NNE 


Cloudy, fair. 


29 


30 


1 


30 


1 


74 


85 


SSE 


NE 


Cloudy, ditto, rain. 


30 


30 


1 


30 





73 


86 


S 


SW 


Cloudy, fair. 


31 


29 


9 


29 


8 


76 


80 


SSW 


SW 


Cloudy, rain, fair. 



BILIOUS YELLOW FEVER OF 1793. 



121 



AUGUST, 1793. 







Barom. 


Ther. 




Winds. 


W 


— - 

eather. 


r. 




2 


S 


i 


< 


& 


i 


i 


£ 


rt 




•< 


eu 


< 


h 


< 


A 


< 


04 


3 




U3 


CO 


<c 


co 


<o 


CO 


o 


CO 


1 


29 


95 


30 C 


65 


77 


WNW NW 


Cloudy, 


Fair, 


s 


30 


1 


30 l\63 


81 


NW 


SW 


Fair, 


Far, 


3 


30 


6 


29 95 


62 


82 


N 


NNE 


Fair, 


Fair, 


4 


29 


97 


30 


65 


87 


S 


SW 


Fair, 


Fair, 


5 


30 


5 


30 1 


73 


90 


ss vv 


sw 


Fair, 


Fair, 


6 


30 


2 


30 


77 


87 


sw 


w 


Cloudy, 


Fair, 


7 


30 


12 


30 1 


68 


83 


NW 


w 


Fair, 


Fair, 


H 


30 


1 


29 95 


69 


86 


SSE 


SSE 


Fair, 


Rain, 


9 


29 


8 


29 75 


75 


85 


ssvv 


SW 


Cloudy, 


Fair, 


10 


29 


9 


29 9 


67 


82 


w 


SW 


Fair, 


Fair, 


1 I 


so- 





30 


70 


84 


sw 


wsw 


Cloudy, 


Cloudy, 


1 2 


so 





30 


70 


87 


\v 


w 


Fair, 


Fair, 


1 3 


30 


5 


30 


71 


89 


sw 


w 


Fair 


Fair, 


1 1 


30 





29 95 


75 


82 


sw 


sw 


Fair, 


Riin, 


15 


30 





30 1 


72 


75 


NNE 


NE 


Fair, 


Cloudy, 


16 


30 


1 


30 1 


70 


83 


NNE 


NE 


Fair, 


Fair, 


17 


30 


1 


30 


71 


86 


SW 


SW 


Fair, 


Fair, 


18 


30 


1 


30 t 


73 


89 


Calm 


sw 


Fair, 


Fair, 


IS 


30 


1 


30 


72 


82 


M 


N 


Fair, 


Cloudy, 


20 


30 


1 


30 12 


64 


82 


NNE 


NNE 


Fair, 


Fair, 


21 


30 


15 


30 25 


62 


83 


N 


NNE 


Fair, 


Fair, 


22 


30 


3 


30 35 


63 


86 


NE 


SE 


Fair, 


Fair, 


23 


30 


25 


30 15 


63 


85 


Calm 


s 


Fair, 


Fair, 


24 


30 


1 


30 1 


73 


81 


Calm 


Calm 


Cloudy, 


Rain, 


25 


30 


1 


30 i 


71 


66 


NE 


NE 


Rain, 


Gr. rain 


26 


30 


15 


30 2 


59 


69 


NE 


NE 


Cloudy, 


Cloudy, 


11 


30 


2 


30 2 


65 


7- 


NE 


NE 


Cloudy, 


Cloudy, 


26 


30 


2 


30 15 


57 


80 


S 


Calm 


Cloudy, 


Clearin. 


J9 


30 


16 


30 15 


72 


86 


Calm 


SW 


Cloudy, 


Fair, 


to 


30 


1 


30 1 


74, 


87 


Calm 


SW 


Fair, 


Fair, 


31 


30 





30 74 


84 


SW 


NW 


Rain, 


Fan , 

: i ' 



VOL. III. 



122 



AN ACCOUNT OF THE 



SEPTEMBER, 1793. 



» — : 


B 


arom. 




Ther. 


\ v inds 


We 


ather. 




jjj 


a 




£ 


S 


S 


i 


8 


i 




< 


h 




< 


0. 


< 


h 


< 


t* 


q 


jd 


CO 




*o 


CO 


ID 


CO 


<o 


eo 


i 


30 


29 


30 


71 


86 


Calm 


SW 


Fog, 


Fair, 


2 


29 


75 29 


8 


73 


86 


SW 


SW 


Fair, 


Fair, 


3 


30 







60 




NW 


N 


Fair, 


Fair, 


4 


30 


15 30 


15 


55 


75 


w 


w 


Fair, 


Fair, 


5 


30 


15 3 


1 


62 


80 


t<E 


s 


Fair, 


Cloudy, 


6 


29 


97 29 


95 


70 


89 


wsw 


w 


Fair, 


Cloudy, 


7 


30 


30 





65 


77 


W'NW NW 


Fair, 


Fair, 


8 


30 


1 30 


1 


64 


70 


Calm 


Calm 


Cloudy, 


Cloudy, 


^ 


30 


30 





66 


80 


SE 


NW 


Run, 


Fair, 


10 


30 


30 





64 


72 


N 


NNE 


Fair 


Cloudy, 


1 1 


30 


1 30 





62 


72 


NNE 


N 


Cloudy, 


Fair, 


12 


29 


96 29 


9 


58 


76 


NW 


NNW 


Fair, 


Fair, 


13 


29 


95 30 





57 


72 


NW 


N 


Fair, 


Fair, 


14 


30 


30 


5 


58 


79 


NW 


NW 


Fair, 


Fair, 


15 


30 


39 


97 


65 


80 


N 


s 


Fair, 


Fair, 


16 


29 


9 29 




70 


84 


S 


SW 


Cloudy, 


Fair, 


17 


29 


8 29 


8: 


66 


67 


N 


N 


Cloudy, 


Cloudy, 


18 


30 


3 




44 




N 




Fair, 




19 


30 


4 30 


35 


45 


70 


Calm 


SW 


Fair, 


Fair, 


2 


V) 


3 30 


15 


54 


69 


Calm 


SE 


Hazy, 


Hazy, 


2, 


30 


29 





59 


78 


Calm 




Cloudy, 


Fair, 


22 


30 


30 





63 


83 


Calm 




Cloudy, 


Fair, 


23 


30 


1 30 


1 


62 


— 


Calm 


SE 


Cloudy, 


Cloudy, 


24 


30 


2 30 


2 


65 


70 


NE 


ENE 


Cloudy, 


Fair, 


25 


30 


15 30 





61 


68 


NE 


NE 


Cloudy, 


Cloudy, 


26 29 


8 29 


7 


58 


79 


N 


N 


Cloudy, 


Fair, 


27 20 


7 




64 




NW 


NW 


Cloudy, 


Fair, 


28 30 


5 30 


15 


54 


73 


NW 


NW 


i 'air, 


Fair, 


29 30 
[1 301 30 


3 30 


3 


56 


74 


NE 


ENE 


Cloudy, 


Fair, 


35 30 


3 


57 


75 


Calm 


S vv 


Foggy, 


Fair. 



BILIOUS YELLOW FEVER OF 1793. 



123 



OCTOBER, 1793. 



— 




Barom. 


1 Ther. 


Winds. 


Weather. 


•75 




s 


S3 


a 


£ 


<t 


a 


i 


i 


- 




< 


b 


< 


fc 


•i 


04 


< 


u* 


a 


i 


tm 


(N 




t^ 


<N 


t~ 


CN 


»- 


(N 


i 


30 


15 


30 


5 


64 


80 


svv 


SW 


Cloudy, 


Fair, 


2 


29 


9 


30 


5 


70 


72 


vv 


NNW 


Cloudy, 


Fair, 


ii 


30 


2 


30 


15 


50 


72 


w 


SW 


Fair, 


Fair, 


1 


29 


75 


29 


7 


59 


72 


sW 


w 


Cloudy, 


Cloudy, 


5 


30 





30 


1 


58 


66 


N 


N 


Fair, 


Fair, 


6 


30 


3 


30 


3 


43 


66 


NE 


w 


Fair, 


Fair, 


7 


30 


45 






46 




Calm 




Fair, 




8 


30 


6 


30 


6 


53 


68 


N 


N 


Fair, 


Fair, 


9 


30 


5 


30 


4 


53 


70 


NW 


NW 


Fair, 


Fair, 


10 


30 


2 


30 


2 


49 


74 


E 


NW 


Fair, 


Fair, 


11 


30 





29 


85 


51 


74 


W 


W 


Fair, 


Fair, 


12 


29 


6 


29 


55 


58 


64 


SW 


NW 


Rain, 


Rain, 


1 j 


29 


85 


29 


9 


49 


69 


NW 


NW 


Fair, 


Fair, 


14 


39 


5 


30 





52 


76 


SW 


svv 


Calm, 


Fair, 


15 


29 


75 


29 


8 


5 6 


54 


SW 


N 


Fair, 


Rain, 


16 


SO 


9 


30 





37 


53 


NNW 


N 


Fair, 


Fair, 


17 


30 


1 


30 


1 


37 


60 


NE 


NE 


Fair, 


Fair, 


18 


30 


1 


30 


1 


41 


62 


NW 


NW 


Fair, 


Fair, 


19 


30 





29 


9 


51 


66 


N 


N 


Cloudy, 


Fair, 


30 


30 





30 





44 


54 


NW 


N 


Fair, 


F'air, 


21 


30 





30 


2 


49 


59 


N 


NW 


Fair, 


Fair, 


22 


89 


6 


29 


5 


51 


65 


NW 


NW 


Fair, 


Fair, 


23 


29 


8 


29 


8 


47 


60 


W 


W 


Fair, 


Fair, 


24 


30 


3 


30 


4 


36 


59 


W 


NW 


Fair, 


Fair, 


25 


30 


4 


30 


3 


46 


71 


S 


S 


Cloudy, 


Do. h w 


26 


30 


2 


30 


2 


60 


72 


Calm 


SW 


Cloudy, 


Cloudy 


27 


80 


3 


30 


.i 


n 


44 


NNE 


NNE 


Cloudy, 


Cloudy 


28 


30 


2 


30 


i 


34 


37 


N 


N 


Cloudy, 


Cloudv. 


29 


29 


85 


29 


» 5 


28 


44 


NNW 


NW 


Fair, 


Fair, ' 


30 


30 


1 


30 


1 ! 


28 


49 


Calm 


SVV 


Hazv, 


Hazv 


31 


30 


15 


30 


2142 


45 


Calm 


NNE 


Cloudy 


Ra 



124 



AN ACCOUNT OF THE 



NOVEMBER, 1793. 



p= 


Bai 


om. 


Th 


er. 


w 


inds. 


Weather. 




£ 


g 


3 


S 


s 


£' 


s 


a 


>- 


'< 


P4 


< 


i* 


< 


tZ 


< 


0. 


a 


t^ 


CN 


^ 


CM 


t^ 


CN 


*>- 


CN 


1 


30 1 


30 1 


40 


4! 


NNE 


NE 


Rain, 


Cloudy, 


2 


30 3 


30 25 


32 


49 


NNE 


NE 


Fair, 


Fair, 


3 


30 1 


30 


43 


56 


Calm 


SW 


Cloudy, 


Cloudy, 


4 


2j 8 


29 9 


55 


67 


SW 


SW 


Cloudy, 


Fair, 


5 


30 15 


30 1 


50 


64 


NE 


NE 


Rain, 


Rain, 


6 


29 8 


29 65 


63 


67 


S 


S 


Cloudy, 


Cloudy, 


7 


29 8 


29 8 


44 


64 


Calm 


SW 


Fair, 


Fair, 


8 


29 8 


29 85 


43 


56 


ssw 


SW 


Fair, 


Fair, 


9 

__ 


29 9 


29 95 


42 


64 


SW 


SW 


Fair, 


Fair. 



BILIOUS YELLOW FEVER OF 1793. 125 



OF THE METHOD OF CURE- 

IN the introduction to the history of the fever, I men 
tioned the remedies which I used with success, in several 
cases which occurred in the beginning of August. I had 
seen, and recorded in my note book, the efficacy of gentle 
purges in the yellow fever of 1762 ; but finding them un- 
successful after the 20th of August, and observing the dis- 
ease to assume uncommon symptoms of great prostration 
of strength, I laid them aside, and had recourse to a gentle 
vomit of ipecacuanha, on the first day of the fever, and to 
the usual remedies for exciting the action of the sanguife- 
rous system. I gave bark in all its usual forms of infusion, 
powder, and tincture. I joined wine, brandy, and aroma- 
tics with it. I applied blisters to the limbs, neck, and head. 
Finding them all ineffectual, I attempted to rouse the sys- 
tem by wrapping the whole body, agreeably to Dr. Hume's 
practice in blankets dipped in warm vinegar. To these 
remedies I added one more : I rubbed the right side with 
mercurial ointment, with a view of exciting the action of 
the vessels in the whole system through the medium of the 
liver, which I then supposed to be principally, though 
symptomatically, affected by the disease. None of these 
remedies appeared to be of any service ; for although three 
out of thirteen recovered, of those to whom they were ap- 
plied, yet I have reason to believe that they would have 
recovered much sooner had the cure been trusted to nature. 
Perplexed and distressed by my want of success in the 
treatment of this fever, I waited upon Dr. Stevens, an emi- 
nent and worthy physician from St. Croix, who happened 
then to be in our city, and asked for such advice and in- 
formation upon the subject of the disease, as his extensive 
practice in the West- Indies would naturally suggest. He 
politely informed me, that he had long ago laid aside eva- 
cuations of all kinds in the yellow fever ; that they had been 
found to be hurtful, and that the disease yielded more rea- 
dily to bark, wine, and, above all, to the use of the cold 
bath. He advised the bark to be given in large quantities 
by way of clyster, as well as in the usual way ; and he in- 



126 AN ACCOUNT OF THE 

formed me of the manner in which the cold bath should be 
used, so as to derive the greatest benefit from it. This mode 
of treating the yellow fever, appeared to be reasonable. I had 
used bark, in the manner he recommended it, in several cases 
of sporadic yellow fever, with success, in former years. I 
had, moreover, the authority of several other physicians of 
reputation in its favour. Dr. Cleghom tells us, that " he 
sometimes gave the bark when the bowels were full of 
vicious humours. These humours (he says) are produced 
by the fault of the circulation. The bark, by bracing the 
solids, enables them to throw off the excrementitious fluids, 
by the proper emunctories."* 

I began the use of each of Dr. Stevens's remedies the 
next day after my interview with him, with great confidence 
of their success. I prescribed bark in large quantities : 
in one case I ordered it to be injected into the bowels every 
four hours. I directed buckets full of c^ld water to be 
thrown frequently upon my patients. The bark was offen- 
sive to the stomach, or rejected by it, in every case in which 
I prescribed it. The cold bath was grateful, and produced 
relief in several cases, by inducing a moisture on the skin. 
For a while I had hopes of benefit to my patients from the 
use of these remedies, but, in a few days, I was distressed 
to find they were not more effectual than those I had pre- 
viously used. Three out of four of my patients died, to 
whom the cold bath was administered, in addition to the 
tonic remedies before mentioned. 

Baffled in every attempt to stop the ravages of this fever, 
I anticipated all the numerous and complicated distresses 
in our city, which pestilential diseases have so often pro- 
duced in other countries. The fever had a malignity and 
an obstinancy which I had never before observed in any 
disease, and it spread with a rapidity and mortality far 
beyond what it did in the year 1762. Heaven alone bore 
witness to the anguish of my soul in this awful situation. 
But I did not abandon a hope that the disease might yet be 
cured. I had long believed that good was commensurate 
with evil, and that there does not exist a disease for which 
the goodness of Providence has not provided a remedy. 
Under the impression of this belief I applied myself with 
fresh ardour to the investigation of the disease before me* 
I ransacked my library, and pored over every book that 

* Page 223. 



BILIOUS YELLOW FEVER OF 1793. 127 

treated of the yellow fever. The result of my researches 
for a while was fruitless. The accounts of the symptoms 
and cure of the disease by the authors I consulted were 
contradictory, and none of them appeared altogether appli- 
cable to the prevailing epidemic. Before I desisted from 
the inquiry to which' I had devoted myself, I recollected 
thai 1 had, among some old papers, a manuscript account 
of the yellow fever as it prevailed in Virginia in the year 
1741, which had been put into my hands by Dr. Franklin, 
a short time before his death. I had red it formerly, and 
made extracts from it into my lectures upon that disease. 
I now read it a secod time. I paused upon every sentence; 
even words in some places arrested and fixed my attention. 
In reading the history of the method of cure I was much 
struck with the following passages. 

" It must be remarked, that this evacuation (meaning 
by purges) is more necessary in this than in most other 
fevers. The abdominal viscera are the parts principally 
affected in this disease, but by this timely evacuation their 
feculent corruptible contents are discharged, before they 
corrupt and produce any ill effects, and their various emunc- 
tories and secerning vessels are set open, so as to allow 
a free discharge of their contents, and consequently a secu- 
rity to the parts themselves, during the course of the dis- 
ease. By this evacuation the very minera of the disease, 
proceeding from the putrid miasmata fermenting with the 
salivary, bilious, and other inquiline humours of the body, 
is sometimes eradicated by timely emptying the abdominal 
viscera, on which it first fixes, after which a gentle sweat 
does as it were nip it in its bud. Where the prima? viae, 
but especially the stomach, is loaded with an offensive 
matter, or contracted and convulsed with the irritation of 
its stimulus, there is no procuring a laudable sweat till that 
is removed ; after which a necessary quantity of sweat 
breaks out of its own accord, these parts promoting it when 
by an absterging medicine they are eased of the burden or 
stimulus which oppresses them.*' 

" All these acute putrid fevers ever require some eva- 
cuation to bring them to a perfect crisis and solution, and 
that even by stools, which must be promoted by art, where 
nature does not do the business herself. On this account 
an ill-timed scrupulousness about the weakness of the body 



128 AN ACCOUNT OF THE 

is of bad consequence in these urging circumstances ; for 
it is that which seems chiefly to make evacuations neces- 
sary, which nature ever attempts, after the humours are fit 
to be expelled, but is not able to accomplish for the most 
part in this disease ; and I can affirm that I have given a 
purge in this case, when the pulse has been so lonv, that it 
could hardly be felt, and the debility extreme, yet both one 
and the other have been restored by it." 

" This evacuation must be procured by lenitive chologo- 
que purges." 

Here I paused. A new train of ideas suddenly broke 
in upon my mind. I believed the weak and low pulse 
which I had observed in this fever, to be the effect of de- 
bility from a depressed state of the system, but the unsuc- 
cessful issue of purging, and even of a spontaneous diarr- 
hoea, in a patient of Dr. Hutchinson, had led me not only 
to doubt of, but to dread its effects. My fears from this 
evacuation were confirmed, by the communication I had 
received from Dr. Stevens. I had been accustomed to 
raising a weak and low pulse in pneumony and apoplexy, 
by means of blood-letting, but I had attended less to the 
effects of purging in producing this change in the pulse. 
Dr. Mitchell in a moment dissipated my ignorance and 
fears upon this subject. I adopted his theory and practice, 
and resolved to follow them. It remained now only to fix 
upon a suitable purge to answer the purpose of dischar- 
ging the contents of the bowels. I have before described 
the state of the bile in the gall-bladder and duodenum, in 
an extract from the history of a dissection made by Dr. 
Mitchell. I suspected that my want of success in dis- 
charging this bile, in several of the cases in which I at- 
tempted the cure by purging, was owing to the feebleness 
of my purges. I had been in the habit of occasionally 
purging with calomel in bilious and inflammatory fevers, 
and had recommended the practice the year before in my 
lectures, not only from my own experience, but upon the 
authority of Dr. Clark. I had, moreover, other prece- 
dents for its use in the practice of Sir John Pringle, Dr. 
Cleghorn, and Dr. Balfour, in diseases of the same class 
with the yellow fever. But these were not all my vouchers 
for the safety and efficacy of calomel. In my attendance 
upon the military hospitals during the late war, I had seen 



BILIOUS YELLOW FEVER OF 1793. 12& 

it given combined with jalap in the bilious fever by Dr. 
Thomas Young, a senior surgeon in the hospitals. His 
usual dose was ten grains of each of them. This was 
given once or twice a day until it procured large evacua- 
tions from the bowels. For a while I remonstrated with 
the doctor against this purge, as being disproportioned to 
the violence and danger of the fever ; but I was soon sa- 
tisfied that it was as safe as cremor tartar or glauber's salts. 
It was adopted by several of the surgeons of the hospital, 
and was universally known, and sometimes prescribed, by 
the simple name of ten and ten. This mode of giving 
calomel occurred to me in preference to any other. The 
jalap appeared to be a necessary addition to it, in order to 
quicken its passage through the bowels; for calomel is 
slow in its operation, more especially when it is given in 
large doses. I resolved, after mature deliberation, to pre- 
scribe this purge. Finding ten grains of jalap insufficient 
to carry the calomel through the bowels in the rapid man- 
ner I wished, I added fifteen grains of the former to ten of 
the latter ; but even this dose was slow and uncertain in 
its operation. I then issued three doses, each consisting 
of fifteen grains of jalap and ten of calomel ; one to be 
given every six hours until they procured four or five large 
evacuations. The effects of this powder not only answer- 
ed, but far exceeded my expectations. It perfectly cured 
four out of the first five patients to whom I gave it, not- 
withstanding some of them were advanced several days in 
the disease. Mr. Richard Spain, a block-maker, in Third- 
Street, took eighty grains of calomel, and rather more' of 
rheubarb and jalap mixed with it, on the two last days of 
August, and on the first day of September. He had 
passed twelve hours, before I began to give him this medi- 
cine, without a pulse, and with a cold sweat on all his 
limbs. His relations had given him over, and one of his 
neighbours complained to me of my neglecting to advise 
them to make immediate preparations for his funeral. But 
in this situation I did not despair of his recovery. Dr. 
Mitchell's account of the effects of purging in raising the 
pulse, excited a hope that he might be saved, provided his 
bowels could be opened. I now committed the exhibition 
of the purging medicine to Mr. Stall, one of my pupils, 
who mixed it, and gave it with his own hand, three or 

VOL. III. R 



130 AN ACCOUNT OF THE 

four times a day. At length it operated, and produced two 
copious, foetid stools. His pulse rose immediately after- 
wards, and a universal moisture on his skm succeeded the 
cold sweat on his limbs. In a few days he was out of dan- 
e-er and soon afterwards appeared in the streets in good 
health, as the first fruits of the efficacy of mercurial purges 
in the vellow fever. 

After such a pledge of the safety and success ot my new 
medicine, I gave it with confidence. I communicated the 
prescription to such of the practitioners as I met in the 
streets. Some of them I found had been in the use of 
calomel for several days, but as they had given it in small 
and single doses only, and had followed it by large doses 
of bark, wine, and laudanum, they had done little or no 
good with it. I imparted the prescription to the college of 
physicians, on the third of September, and endeavoured to 
remove the fears of my fellow-citizens, by assuring them 
that the disease was no longer incurable. Mr. Lewis, the 
lawyer, Dr. M'llvaine, Mrs. Bethel, her two sons, and a 
servant maid, and Mr. Peter Baynton's whole family (nine 
in number,) were some of the first trophies of this new 
remedy. The credit it acquired, brought me an immense 
accession of business. It still continued to be almost uni- 
formly effectual in all those which I was able to attend, 
either in person, or by my pupils. Dr. Griffitts, Dr. Say, 
Dr. Pennington, and my former pupils who had settled in 
the city, viz. Dr. Leib, Dr. Porter, Dr. Annan, Dr. Wood- 
house,' and Dr. Mease, were among the first physicians who 
adopted it. I can never forget the transport with which 
Dr. Pennington ran across Third-street to inform me, a few 
days after he began to give strong purges, that the disease 
yielded to them in every case. But I did not rely upon 
purging alone to cure the disease. The theory of it which I 
had adopted led me to use other remedies to abstract excess 
of stimulus irom the system. These were blood-letting, 
cool air, cold drinks, low diet, and applications of cold water 
to the body. I had bled Mrs. Bradford, Mrs. Learning, 
and one of Mrs. Palmer's sons without success, early in the 
month of August. But I had witnessed the bad effects of 
bleeding in the first week in September, in two of my pa- 
tients who had bled without my knowledge, and who ap- 
peared to have died in consequence of it. I had, more- 



BILIOUS YELLOW FEVER OF 1793. 131 

over, heard oi a man who had been bled on the first day of 
the disease, who had died in twelve hours afterwards. 
These cases produced caution, but they did not deter me 
from bleeding as soon as I found the disease to change its 
type, and instead of tending to a crisis on the third, to pro- 
tract itscli to a later day. I began by drawing a small 
quantity at, a time. The appearance of the blood, and its 
effects upon the system, satisfied me of its safety and effi- 
cacy. Never before did I experience such sublime joy as 
[ now felt in contemplating the success of my remedies. 
It repaid me for all the toils and studies of my life. The 
conquest of this formidable disease was not the effect of 
accident, nor of the application of a single remedy ; but it 
was the triumph of a principle in medicine. The reader 
will not wonder at this joyful state of my mind when I add 
a short extract from my note book, dated the 10th of Sep- 
tember. " Thank God ! out of one hundred patients, 
whom I have visited or, prescribed for this day, I have lost 
none." 

Being unable to comply with the numerous demands 
which were made upon me for the purging powders, not- 
withstanding I had requested my sister, and two other per- 
sons to assist my pupils in putting them up ; and, finding 
myself unable to attend all the persons who sent for me, I 
furnished the apothecaries with the recipe for the mercurial 
purges, together with printed directions for giving them, 
and for the treatment of the disease. 

Hitherto there had been great harmony among the phy- 
sicians of the city, although there was a diversity of senti- 
ment as to the nature and cure of the prevailing fever. But 
this diversity of sentiment and practice was daily lessening, 
and would probably have ceased altogether in a few days, 
had it not been prevented by two publications, the one by 
Dr. Kuhn, and the other by Dr. Stevens, in which they 
recommended bark, wine, and other cordials, and the cold 
bath, as the proper remedies for the disease. The latter 
dissuaded from the use of evacuations of all kinds. This 
method of cure was supported by a letter from Alexander 
Hamilton, Esq. then secretary of the treasury of the United 
States, to the college of physicians, in which he ascribed 
his recover}- from the fever to the use of those remedies, 
administered by the hand of Dr. Stevens. The respectable 



132 AN ACCOUNT OF THE 

characters of those two physicians procured an immediate 
adoption of the mode of practice recommended by them, 
by most of the physicians of the city, and a general confi- 
dence in it by all classes of citizens. Had I consulted my 
interest, or regarded the certain consequences of opposing 
the use of remedies rendered suddenly popular by the 
names that were connected with them, I should silently 
have pursued my own plans of cure, with my old patients 
who still confided in them ; but I felt, at this season of 
universal distress, my professional obligations to all the 
citizens of Philadelphia to be superior to private and per- 
sonal considerations, and therefore determined at every 
hazard to do every thing in my power to save their lives. 
Under the influence of this disposition, I addressed a letter 
to the college of physicians, in which I stated my objec- 
tions to Dr. Kuhn and Dr. Stevens's remedies, and de- 
fended those I had recommended. I likewise defended them 
in the public papers against the attacks that were made 
upon them by several of the physicians of the city, and 
occasionally addressed such advice to the citizens as expe- 
rience had suggested to be useful to prevent the disease, 
particularly low diet, gentle doses of laxative physic, avoid- 
ing its exciting causes, and prompt applications for medi- 
cal aid. In none of the recommendations of my remedies 
did I claim the credit of their discovery. On the contrary, 
I constantly endeavoured to enforce their adoption by men- 
tioning precedents in favour of their efficacy, from the 
highest authorities in medicine. This controversy with my 
brethren, with whom I had long lived in friendly intercourse, 
carried on amidst the most distressing labours, was ex- 
tremely painful to me, and' was submitted to only to pre- 
vent the greater evil of the depopulation of our city by the 
use of remedies which had been prescribed by myself, as 
well as others, not only without effect, but wiih evident in- 
jury to the sick. The repeated and numerous instances of 
their inefficacy, in some of the most opulent families in the 
city, and the almost uniform success of the depleting re- 
medies, happily restored the public mind, afier a while, 
from its distracted state, and procured submission to the 
latter from nearly all the persons who were affected by the 
fever. 

Besides the two modes of practice which have been 



BILIOUS YELLOW FEVER OF 1793. 1S3 

scribed, there were two others : the one consisted of mode- 
rate purging with calomel only, and moderate bleeding, on 
the first or second day of the fever, and afterwards by the 
copious use of bark, wine, laudanum, and aromatic tonics. 
This practice was supported by an opinion, that the fever 
was inflammatory in its first, and putrid in its second stage. 
The other mode referred to was peculiar to the French 
physicians, several of whom had arrived in the city from 
the West- Indies, just before the disease made its appear- 
ance. Their remedies were various. Some of them pre- 
scribed nitre, cremor tartar, camphor, centaury tea, the 
warm bath, clysters, and moderate bleeding, while a few 
used lenient purges, and large quantities of tamarind water, 
and other diluted drinks. The dissentions of the American 
physicians threw a great number of patients into the hands 
of these French physicians. They were moreover supposed 
to be better acquainted with the disease than the physicians 
of the city, most of whom, it was well known, had never 
seen it before. 

I shall hereafter inquire into the relative success of each 
of the four modes of practice which have been mentioned. 

Having delivered a general account of the remedies 
which I used in this disease, I shall now proceed to make 
a few remarks upon each of them. I shall afterwards men- 
tion the effects of the remedies used by other physicians. 



OF PURGING. 

I HAVE already mentioned my reasons for promot- 
ing this evacuation, and the medicine I preferred for that 
purpose. It had many advantages over any other purge. 
It was detergent to the bile and mucus which lined the 
bowels. It probably acted in a peculiar manner upon the 
biliarv ducts, and it was rapid in its operation. One dose 
was sometimes sufficient to open the bowels ; but from two 
to six doses were often necessary for that purpose ; more 
especially as part of them was frequently rejected by the 
stomach. I did not observe any inconvenience from the 
vomiting which was excited by the jalap. It was always 



134 AN ACCOUNT OF THE 

without that straining which was produced by emetics ; and 
it served to discharge bile when it was lodged in the sto- 
mach. Nor did 1 rest the discharge of the contents of the 
bowels on the issue of one cleansing on the first day. 
There .s, in all bilious fevers, a reproduction of morbid 
bile as fast as it is discharged. Itheretore gave a purge every 
day while the fever continued. I used castor oil, salts, 
cremor tartar, and rheubarb (after the mercurial purges had 
performed their office,) according to the inclinations of my 
patients, in all those cases where the bowels were easily 
moved ; but where this was not the case, I gave a single 
dose of calomel and jalap every day. Strong as this purge 
may be supposed to be, it was often ineffectual ; more es- 
pecially after the 20th of September, when the bowels be- 
came more obstinately constipated. To supply the place 
of the jalap, I now added gamboge to the calomel. Two 
grains and a half of each, made into a pill, were given to 
an adult every six hours, until they procured four or five 
stools. I had other designs in giving a purge every day, 
besides discharging the re-accumulated bile. I had ob- 
served the fever to fall with its principal force upon such 
parts of the body as had been previously weakened by any 
former disease. By creating an artificial weak part in the 
bowels, I diverted the force of the fever to them, and there- 
by saved the liver and brain from fatal or dangerous con- 
gestions. The practice was further justified by the bene- 
ficial effects of a plentiful spontaneous diarrhoea, in the 
beginning of the disease ;* by haemorrhages from the bow- 
els, when they occurred from no other parts of the body, 
and by the difficulty or impracticability of reducing the 
system by means of plentiful sweats. The purges seldom 
answered the intentions for which they were given, unless 
they produced four or five stools a day. As the lever 
showed no regard to day or night in the hours of its exa- 
cerbations, it became necessary to observe the same disre- 
gard to time in the exhibition of purges : I therefore pre- 

* In some short manuscript notes upon Dr. Mitchell's account of the 
yellow fever in Virginia, in the year 1741, made by the late Dr. Kearsley, 
sen. of this city, he remarks, that in the yellow fever which prevailed in 
the same year in Philadelphia, " some recovered by an early discharge of 
black matter by stool." This gentleman, Dr Redman informed me, intro- 
duced purging with glauber's salts in the yellow fever in our city. He' 
was preceptor to Dr. Redman in medicine. 



BILIOUS YELLOW FEVER OF 1793. 135 

scribed them in the evening, at all times when the patient 
had passed a day without two or three plentiful stools. When 
purges were rejected, or slow in their operation, I always 
directed opening clysters to be given every two hours. The 
effects of purging were as follow : 

1. It raised the pulse when low, and reduced it when it 
was preternaturally tense or full. 

2. It revived and strengthened the patient. This was 
evident in many cases, in the facility with which patients 
who had staggered to a close-stool, walked back again to 
their beds after a copious evacuation. Dr. Sydenham takes 
notice of a similar increase of strength after a plentiful 
sweat in the plague. They both acted by abstracting ex- 
cess of stimulus, and thereby removing the depsession of 
the system. 

3. It abated the paroxysm of the fever. Hence arose 
the advantage of giving a purge in some cases in the evening, 
when an attack of the fever was expected in the course of 
the night. 

4. It frequently produced sweats when given on the first 
or second day of the fever, after the most powerful sudori- 
fics had been taken to no purpose. 

5. It sometimes checked that vomiting which occurs in 
the beginning of the disease, and it always assisted in pre- 
venting the more alarming occurrence of that symptom 
about the 4th or 5th day. 

6. It removed obstructions in the lymphatic system. I 
ascribe it wholly to the action of mercury, that in no in- 
stance did any of the glandular swelling, which I formerly 
mentioned, terminate in a suppuration. 

7. By discharging the bile through the bowels as soon 
and as fast as it was secreted, it prevented, in most cases, a 
yellowness of the skin. 

However salutary the mercurial purge was, objections 
were made to it by many of our physicians; and prejudices, 
equally weak and ill-founded, were excited against it. I 
shall enumerate, and answer those objections. 

1. It was said to be of too drastic a nature. It was com- 
pared to arsenic ; and it was called a dose for a horse. 
This objection was without foundation. Hundred o 
took it declared they had never taken so mild a purge. I 



136 AN ACCOUNT OF THE 

met with but one case in which it produced bloody stools; 
but I saw the same effects from a dose of salts. It some- 
times, it is true, operated from twenty to thirty times in 
the course of twenty-four hours ; but I heard of an equal 
number of stools in two cases from salts and cremor tartar. 
It is not an easy thing to affect life, or even subsequent 
health, by copious or frequent purging. Dr. Kirkland 
mentions a remarkable case of a gentleman who was cured 
of rheumatism, by a purge, which gave him between 40 
and 50 stools. This patient had been previously affected 
by his disease 16 or 18 weeks.* Dr. Moseley not only 
proves the safety, but establishes the efficacy of numerous 
and copious stools in the yellow fever. Dr. Say probably 
owes his life to three and twenty stools procured by a dose 
of calomel and gamboge, taken by my advice. Dr. Red- 
man was purged until he fainted by a dose of the same 
medicine. This venerable gentleman, in whom 70 years 
had not abated the ardour of humanity, nor produced 
obstinacy of opinion, came forward from his retirement, 
and boldly adopted the remedies of purging and bleeding, 
with success in several families, before he was attacked by 
the disease. His recovery was as rapid, as the medicine he 
had used was active in its operation. Besides taking the 
above purge, he lost twenty ounces of blood by two 
bleedings. f 

But who can suppose that a dozen or twenty stools in a 
day could endanger life, that has seen a diarrhoea continue 
for several months, attended with fifteen or twenty stools 
every day, without making even a material breach in the 

* Treatise on the Inflammatory Rheumatism, vol. i. p. 407- 
f Dr. Redman was not the only instance furnished by the disease, in 
which reason cot the better of the habits of old age, and "if the form 
of medicine. About the time the fever declined, I received a letter from 
Dr. Shippen, sen. (then above 82 years of age,) dated Oxford Furnace, 
New-Jersey, October 13th, 1793, in which, after approving in polite terms 
of my mode of practice, he adds, " Desperate diseases require desperate 
remedies. I would only propose some small addition to your present n> thod. 
Suppose you should substitute, in the room of the jalap, six g> .•'. is f gam* 
boge, to be mixed with ten or fifteen grains of calomel ; and fl / t dose 
or two, as occasion may require, you should bleed your patients almost 
to death, at least to fainting ,• and then direct a plentiful supply of mallows 
tea, with fresh lemon juice, and sugar and barley water, together with the 
most simple, mild and nutritious food " The doctor concludes Ins Utter by 
recommending to my perusal Dr Lover's account of nearly a whole ship's 
crew having been cured of a yellow fever, on the coast of South-America., 
by being bled until they fainted. 



BILIOUS YEI.LOW FEVER OF 1793. 137 

constitution ? Hence Dr. Hillary has justly remarked, that 
" it rarely or never happens that the purging in this disease, 
though violent, takes the patient off, but the fever and 
inflammation of the bowels."* Dr. Clark in like manner 
remarks, that evacuations do not destroy life in the dysen- 
tery, but the fever, with the emaciation and mortification 
which attend and follow the disease.f 

2. A second objection to this mercurial purge was, that 
it excited a salivation, and sometimes loosened the teeth. 
I met with but two cases in which there was a loss of teeth 
from the use of this medicine, and in both the teeth Were 
previously loose or decayed. The salivation was a trifling 
evil, compared with the benefit which was derived from it. 
I lost only one patient in whom it occurred. I was taught, 
by this accidental effect of mercury, to administer it with 
other views than merely to cleanse the bowels, and with a 
success which added much to my confidence in the power 
of medicine over the disease. 1 shall mention those views 
under another head. 

3. It was said that the mercurial purge excoriated the 
rectum, and produced the symptoms of pain and inflam- 
mation in that part, which were formerly mentioned. 

To refute this charge, it will be sufficient to remark, that 
the bile produces the same excoriation and pain in the 
rectum in the bilious and yellow fever, where no mercury 
has been given to discharge it. In the bilious remitting 
fever which prevailed in Philadelphia in 1780, we find the 
bile which was discharged by " gentle doses of salts, and 
creamor tartar, or the butternut pill, was so acrid as to 
excoriate the rectum, and so offensive as to occasion, in 
some cases, sickness and faintness both in the patients, and 
in their attendants. "J 

Dr. Hume says further upon this subject, that the rectum 
Was so much excoriated by the natural discharge of bile in 
the yellow fever, as to render it impossible to introduce a 
clyster pipe into it. 

4. It was objected to this purge, that it inflamed and 
itcd the stomach and bowels. In support of this 

calumny, the inflamed and mortified appearances, which 

* Diseases of Barbadoes, p. 212. 

j Diseases in Voyages to Hot Climates, vol. ii. p. 322- 

i Vol. i. 

VOL. III. S 



138 AN ACCOUNT OF THE 

those viscera exhibited upon dissection in a patient who 
died at the hospital at Bush-hill, were spoken of with 
horror in some parts of the city. To refute this objection 
it will only be necessary to review the account formerly 
given of the state of the stomach and bowels after death 
from the yellow fever, in cases in which no mercury had 
been given. I have before taken notice that sir John 
Pringle and Dr. Cleghorn had prescribed mercurial purges 
with success in the dysentery, a disease in which the bow- 
els are affected with more irritation and inflammation than 
in the yellow fever. Dr. Clark informs us that he had 
adopted this practice. I shall insert the eulogium of this 
excellent physician upon the use of mercury in the dysen- 
tery in his own words. " For several years past, when the 
dysentery has resisted the common mode of practice, I 
have administered mercury with the greatest success ; and 
am thoroughly persuaded that it is possessed of powers to 
remove inflammation and ulceration of the intestines, which 
are the chief causes of death in this distemper.*'* 

5. It was urged against this powerful and efficacious 
medicine, that it was prescribed indiscriminately in all 
cases, and that it did harm in all weak habits. To this I 
answer, that there was no person so weak in constitution 
or a previous disease, as to be injured by a single dose of 
this medicine. Mrs. Meredith, the wife of the treasurer of 
the United States, a lady of uncommon delicacy of consti- 
tution, took two doses of the powder in the course of twelve 
hours, not only without any inconvenience, but with an 
evident increase of strength soon afterwards. Many similar 
cases might be mentioned. Even children took two or 
three large doses of it with perfect safety. This will not 
surprise those physicians who have been in the practice 
of giving from ten to twenty grains of mercury, with an 
equal quantity of jalap as a worm purge, and from fifty to 
a hundred grains of calomel, in the course of four or five 
days, in the internal dropsy of the brain. But I am happy 
in being able to add further, that many women took it in 
every stage of pregnancy without suffering the least incon- 
venience from it. Out of a great number of pregnant 
women whom I attended in this fever I did not lose one to 
whom I gave this medicine, nor did any of them suffer an 
* Vol. ii. p. 342. 



BILIOUS YELLOW FEVER OF 1793. 139 

abortion. One of them had twice miscarried in the course 
of the two or three last years of her life. She bore a healthy 
child three months after her recovery from the yellow fever. 

No one has ever objected to the indiscriminate mode of 
preparing the body for die small-pox by purging medi- 
cines. The uniform inflammatory diathesis of that disease 
justifies the practice in a certain degree, in all habits. The 
yellow fever admits of a sameness of cure much more 
than the small-pox, for it is mure uniformly and more 
highly inflammatory. An observation of Dr. Sydenham 
upon epidemics applies, in its utmost extent, to our late 
fever. " Now it must be observed (says this most acute 
physician) that some epidemic diseases, in some years, are 
uniformly and constantly the same."* However diversified 
our fever was in some of its symptoms, it was in all cases 
accompanied by more or less inflammatory diathesis, and 
by a morbid state of the alimentary canal. 

Much has been said of the bad effects of this purge 
from its having been put up carelessly by the apothecaries, 
or from its having been taken contrary to the printed direc- 
tions by many people. If it did harm in any one case 
(which I do not believe) from the former of the above 
causes die fault is not mine. Twenty men employed con- 
stantly in putting up this medicine would not have been 
sufficient to have complied with all the demands which 
were made of me for it. Hundreds who were in health 
called or sent for it as well as the sick, in order to have it 
in readiness, in case they should be surprized by the disease 
in the night, or at a distance in the night, or at a distance 
from a physician. 

In all the cases in which diis purge was supposed to 
have been hurtful, when given on the first or second day 
of the disease, I believe it was because it was not followed 
by repeated doses of the same, or of some other purge, or 
because it was not aided by blood-letting. I am led to 
make this assertion, not only from the authority of Dr. 
Sydenham, who often mentions the good effects of bleed- 
ing in moderating or checking a diarrhoea, but by having 
heard no complaints of patients being purged to death by 
this medicine, after blood-letting was universally adopted 
by all the physicians in the city. 

* Vol. i. p. 9. 



140 AN ACCOUNT OF THE 

It was remarked that the demand for this purging pow- 
der continued to increase under all opposition, and that the 
sale of it by the apothecaries was greatest towards the close 
of the disease. I shall hereafter say that this was not the 
case with the West- India remedies. 

It is possible that this purge sometimes proved hurtful 
when it was given on the fifth dav ntf cne disease, but it 
was seldom given for the fir ^ "me after the third day, and 
when it was, the patient was generally in such a situation 
that nothing did him either good or harm. 

I derived great pleasure from hearing, after the fever had 
left the city, that calomel had been given with success as a 
purge in bilious fevers in other parts of the union besides 
Philadelphia. Dr. Lawrence informed me that he had 
cured many patients by it of the yellow fever which pre- 
vailed in New- York, in the year 1791, and the New- York 
papers have told us that several practitioners had been in 
the habit of giving it in the autumnal fevers, with great 
success, in the western parts of that state. They had pro- 
bably learned the use of it from Dr. Young, who formerly 
practised in that part of the United States, and who lost 
no opportunity of making its praise public wherever he 
went. 

I have only to add to my account of that purging medi- 
cine, that, under an expectation that the yellow fever would 
mingle some of its bilious symptoms with the common 
inflammatory fevers of the winter and first spring months, 
I gave that purge in the form of pills, in every case* of in- 
flammatory fever to which I was called. The fatal issue 
of several fevers in the city, during the winter, in which 
this precaution had been neglected, convinced me that my 
practice was proper and useful. 

It is to be lamented that all new remedies are forced to 
pass through a fiery ordeal. Opium and bark were long 
the objects of terror and invective in the schools of medi- 
cine. They were administered only by physicians for 
many years, and that too with all the solemnity of a reli- 
gious ceremony. This error, with respect to those medicines, 
has at last passed away. It will, I hope, soon be succeed- 
ed by a time when the prejudices against ten and ten or ten 
and fifteen, will sleep with the vulgar fears which were 
formerly entertained of the bark producing diseases and 
death, years after it had been taken, by " lying in the bones." 



BILIOUS YELLOW FEVER OF 1793. 141 



OF BLOOD-LETTING. 

THE theory of this fever which led me to administer 
purges, determined me to use blood-letting, as soon as it 
should be indicated. I am disposed to believe that I was 
tardy in the use of this remedy, and I shall long regret the 
loss of three patients, who might probably have been saved 
by it. I cannot blame myself for not having used it ear- 
lier, for the immense number of patients which poured in 
upon mc, in the first week of September, prevented my 
attending so much to each of them as was necessary to 
determine upon the propriety of this evacuation. I was 
in the situation of a surgeon in a battle, who runs to every 
call, and only stays long enough with each soldier to stop 
the bleeding of his wound, while the increase of the 
Mounded, and the unexpected length of the brattle, leave 
his original patients to suffer from the want of more suit- 
able dressings. The reasons which determine me to bleed 
were, 

1. The state of the pulse, which became more tense, in 
proportion as the weather became cool. 

2. The appearance of a moist and white tongue, on the 
first day of the disease, a certain sign of an inflammatory 
fever. 

3. The frequency of haemorrhages from every part of 
the body, and the perfect relief given in some cases by 
them. 

4. The symptoms of congestion in the brain, resem- 
bling those which occur in the first stage of hydrocephalus 
internus, a disease in which I had lately used bleeding with 
success. 

5. The character of the diseases which had preceded the 
yellow fever. They were all more or less inflammatory. 
Even the scarlatina anginosa had partaken so much of that 
diathesis, as to require bleeding to subdue it. 

6. The warm and dry weather which had likewise pre- 
ceded the fever. Dr. Sydenham attributes a highly inflam- 
matory state of the small-pox to a previously hot and dry 
Bummer ; and I have since observed, that Dr. Hillary takes 



\i2 AN ACCOUNT OF THE 

notice of inflammatory fevers having frequently succeeded 
hot and dry weather in Barbadoes.* He informs us fur- 
ther, that the yellow fever is always most acute and inflam- 
matory after a very hot season. | 

7. The authority of Dr. Mosely had great weight with 
me in advising the loss of blood, more especially as his 
ideas of the highly inflammatory nature of the fever ac. 
corded so perfectly with my own. 

8. I was induced to prescribe blood-letting by recollect- 
ing its good effects in Mrs. Palmer's son, whom I bled on 
the 20th of August, and who appeared to have been reco- 
vered by it. 

Having begun to bleed, I was encouraged to continue it 
by the appearance of the blood, and by the obvious and 
very great relief my patients derived from it. 

The following is a short account of the appearances of 
the blood drawn from a vein in this disease. 

1. It was, in the greatest number of cases, without any 
separation into crassamentum and serum, and of a scarlet 
colour. 

2. There was in many cases a separation of the blood 
into crassamentum and yellow serum. 

3. There were a few cases in which this separation took 
place and the serum was of a natural colour. 

4. There were many cases in which the blood was as 
sizy as in pneumony and rheumatism. 

5. The blood was in some instances covered above with 
blue pellicle of sizy lymph, while the part which lay in the 
bottom of the bowl was dissolved. The lymph was in 
two cases mixed with green streaks. 

6. It was in a few instances of a dark colour, and as 
fluid as molasses. I saw this kind of blood in a man who 
walked about his house during the whole of his sickness, 
and who finally recovered. Both this, and the fifth kind 
of blood which has been mentioned, occur chiefly where 
bleeding had been omitted altogether, or used too sparingly 
in the beginning of the disease. 

7. In some patients the blood, in the course of the dis- 
ease, exhibited nearly all the appearances which have been 
mentioned. They were varied by the time in which the 

• Diseases of Barbadoes, p. 16, 43, 46, 43, 52, 122. f Page 174, 



BILIOUS YELLOW FEVER OF 1793. 143 

blood was drawn, and by the nature and force of the reme- 
dies which have been used in the disease. 

The effects of blood-letting upon the system were as 
follow : 

1. It raised the pulse when depressed, and quickened it, 
when it was preternaturally slow, or subject to intermis- 
sions. 

2. It reduced its force and frequency. 

3. It checked in many cases the vomiting which occur- 
red in the beginning of the disease, and thereby enabled 
the stomach to retain the purging medicine. It likewise 
assisted the purge in preventing the dangerous or fatal vo- 
miting which came on about the fifth day. 

4. It lessened the difficulty of opening the bowels. Upon 
this account, in one of my addresses to the citizens of 
Philadelphia, I advised bleeding to be used before, as well 
as after taking the mercurial purge. Dr. Woodhouse in- 
formed me that he had several times seen patients call for 
the close stool while the blood was flowing from the vein. 

5. It removed delirium, coma, and obstinate wakeful- 
ness. It also prevented or checked haemorrhages ; hence 
perhaps another reason why not a single instance of abor- 
tion occurred in such of my female patients as were preg- 
nant. 

6. It disposed, in some cases, to a gentle perspiration. 

7. It lessened the sensible debility of the system ; hence 
patients frequently rose from their beds, and walked across 
their rooms, in a few hours after the operation had been 
performed. 

8. The redness of the eyes frequently disappeared in a 
few hours after bleeding. Mr. Coxe observed a dilated 
pupil to contract to its natural size within a few minutes 
after he had bound up the arm of his patient. I remarked, 
in the former part of this work, that blindness in many in- 
stances attended or followed this fever. But two such cases 
occurred among my patients. In one of them it was of 
short continuance, and in the other it was probably occa- 
sioned by the want of sufficient bleeding. In every case 
of blindness that came to my knowledge bleeding had been 
omitted, or used only in a very moderate degree. 

9. It eased pain. Thousands can testify this effect of 
blood-letting. Many of my patients whom I bled with 



144 AN ACCOUNT OF THE 

my own hand acknowledged to me, while the blood was 
flowing, that they were better ; and some of them declared, 
that all their pains had left them before I had completely 
bound up their arms. 

10. But blood-letting had, in many cases, an effect the 
opposite of easing pain. It frequently increased it in every 
part of the body, more especially in the head. It appeared 
to be the effect of the system rising suddenly from a state 
of great depression, and of an increased action of the blood- 
vessels which took place in consequence of it. I had fre- 
quently seen complaints of the breast, and of the head, 
made worse by a single bleeding, and from the same cause. 
It was in some cases an unfortunate event in the yellow 
fever, for it prevented the blood-letting being repeated, by 
exciting or strengthening the prejudices of patients and 
physicians against it. In some instances the patients grew 
worse after a second, and, in one, after a third bleeding. 
This was the case in Miss Redman. Her pains increased 
after three bleedings, but yielded to the fourth. Her father, 
Dr. Redman, concurred in this seemingly absurd practice. 
It was at this time my old preceptor in medicine reminded 
me of Dr. Sydenham's remark, that moderate bleeding did 
harm in the plague where copious bleeding was indicated, 
and that in the cure of that disease, we should leave nature 
wholly to herself, or take the cure altogether out of her 
hands. The truth of this remark was very obvious. By 
taking away as much blood as restored the blood-vessels 
to a morbid degree of action, without reducing this action 
afterwards, pain, congestion, and inflammation were fre- 
quently increased, all of which were prevented, or occur- 
red in a less degree, when the system rose gradually from 
the state of depression which had been induced by the great 
force of the disease. Under the influence of the facts and 
reasonings which have been mentioned I bore the same 
testimony in acute cases, against what was called moderate 
bleeding that I did against bark, wine, and laudanum in 
this fever. 

11. Blood-letting, when used early on the first day, fre- 
quently strangled the disease in its birth, and generally 
rendered it more light, and the convalescence more speedy 
and perfect. I am not sure that it ever shortened the du- 
ration of the fever where it was not used within a few 



BILIOUS YELLOW FEVER OF 1793. 145 

hours of the time of its attack. Under every mode of 
treatment it seemed disposed, after it was completely form- 
ed, to run its course. I was so satisfied of this peculiarity 
in the fever, that I ventured in some cases to predict the 
day on which it would terminate, notwithstanding I took 
the cure entirely out of the hands of nature. I did not 
lose a patient on the third, whom I bled on the first or se- 
cond day of the disease. 

12. In those cases which ended fatally, blood-letting re- 
stored, or preserved the use of reason, rendered death easy, 
and retarded the putrefaction of the body after death. 

I shall now mention some of the circumstances which 
directed and regulated the use of this remedy. 

1. Where bleeding had been omitted for three days, in 
acute cases, it was seldom useful. Where purging had 
been used, it was sometimes successful. I recovered two 
patients who had taken the mercurial purges, whom I bled 
for the first time on the seventh day. One of them was 
the daughter of Mr. James Cresson, the other was a jour- 
neyman ship-carpenter at Kensington. In those cases 
where bleeding had been used on the first day, it was both 
safe and useful to repeat it every day afterwards, during 
the continuance of the fever. 

2. I preferred bleeding in the exacerbation of the fever. 
The remedy here was applied when the disease was in its 
greatest force. A single paroxysm was like a sudden 
squall to the system, and, unless abated by bleeding or 
purging, often produced universal disorganization. I pre- 
ferred the former to the latter remedy in cases of great 
danger, because it was more speedy, and more certain in 
its oppression. 

3. I bled in several instances in the remission of the 
fever, where the pulse was tense and corded. It lessened 
the violence of the succeeding paroxysm. 

4. I bled in all those cases in which the pulse was pre- 
ternatural ly slow, provided it was tense. Mr. Benj. W. 
Morris, Mr. Thomas Warton, jun. and Mr. Wm. San- 
son!, all owe their lives probably to their having been bled 
in the above state of the pulse. I was led to use bleeding 
in this state of the pulse, not only by the theory of the 
disease which I had adopted, but by the success which had 
wflen attended this remedy, in a slow and depressed state 

VOL. III. T 



146 AN ACCOUNT OF THE 

of the pulse in apoplexy and pneumony. I had moreover 
the authority of Dr. Moseley in its favour, in the yellow 
fever, and of Dr. Sydenham, in his account of a new fever, 
which appeared in the year 1685. The words of the latter 
physician are so apposite to the cases which have been 
mentioned, that I hope I shall be excused for inserting 
them in this place. " All the symptoms of weakness (says 
our author) proceed from nature's being in a manner op- 
pressed and overcome by the first attack of the disease, so 
as not to be able to raise regular symptoms adequate to the 
violence of the fever. I remember to have met with a 
remarkable instance of this, several years ago, in a young 
man 1 then attended ; for though he seemed in a manner 
expiring, yet the outward parts felt so cool, that I could 
not persuade the attendants he had a fever, which could not 
disengage, and show itself clearly, because the vessels were 
so full as to obstruct the motion of the blood. However, 
I said, that they would soon find the fever rise high enough 
upon bleeding him. Accordingly, after taking away a large 
quantity of blood, as violent a fever appeared as ever I met 
with, and did not go off till bleeding had been used three 
or four times."* 

5. I bled in those cases in which the fever appeared in 
a tertian form, provided the pulse was full and tense. I 
well recollect the surprise with which Mr. Van Berkel 
heard this prescription from me, at a time when he was 
»ible to walk and ride out on the intermediate days of a 
tertian fever. The event which followed this prescription 
showed that it was not disproportioned to the violence of 
his disease, for it soon put on such acute and inflam- 
matory symptoms as to require six subsequent bleedings 
to subdue it. 

6. I bled in those cases where patients were able to walk 
about, provided the pulse was the same as has been men- 
tioned under the fourth head. I was determined as to the 
propriety of bleeding in these two supposed mild forms of 
the fever, by having observed each of them, when left to 
themselves, frequently to terminate in death. 

7. I paid no regard to the dissolved state of the blood, 
when it appeared on the first or second day of the disease, 
but repeated the bleedings afterwards in every case, where 

* Vol. ii. p. 351. 



BILIOUS YELLOW FEVER OF 1793. 147 

ihe pulse continued to indicate it. It was common to see 
sizy blood succeed that which was dissolved. This occur- 
red in Mr. Josiah Coates, and Mr. Samuel Powel. Had 
I believed that this dissolved state of the blood arose from 
its putrefaction, I should have laid aside my lancet as soon 
as I saw it ; but I had long ago parted with all ideas of 
putrefaction in bilious fevers. The refutation of this 
doctrine was the object of one of my papers in the Medical 
Society of Edinburgh, in the year' 1767. The dissolved 
appearance of the blood, I suppose to be the effect of a 
certain action of the blood-vessels upon it. It occurs in 
fevers which depend upon the sensible qualities of the air, 
and in which no putrid or foreign matter has been intro- 
duced into the system. 

8. The presence of petechia; did not deter me from 
repeating blood-letting, where the pulse retained its fulness 
or tension. I prescribed it with success in the cases of Dr. 
Mease, and of Mrs. Gebler, in Dock -street, in each of 
whom petechia; had appeared. Bleeding was equally 
effectual in the case of the Rev. Mr. Keating, at a time 
when his arms were spotted with that species of eruptions 
which I have compared to moscheto-bites. I had prece- 
dents in Dr. De Haen* and Dr. Sydenham,! in favour of 
this practice. So far from viewing these eruptions as signs 
of putrefaction, I considered them as marks of the highest 
possible inflammatory diathesis. They disappeared in each 
of the above cases after bleeding. 

9. In determining the quantity of blood to be drawn, I 
was governed by the state of the pulse, and by the tempe- 
rature of the weather. In the beginning of September, I 
found one or two moderate bleedings sufficient to subdue 
the fever ; but in proportion as the system rose by the 
diminution of the stimulus of heat, and the fever put on 
more visible signs of inflammatory diathesis, more frequent 
bleedings became necessary. 1 bled many patients twice, 
and a few three times a day. I preferred frequent and 
small, to large bleedings, in the beginning of September ; 
but towards the height and close of the epidemic, I saw no 
inconvenience from the loss of a pint, and even twenty 
ounces of blood at a time. I drew from many persons 

* Ratio Medendi, vol ii. p. 162. vol. iv. p. 172. 
f Vol. i. p. 210, and 264. 



148 AN ACCOUNT OP THE 

seventy and eighty ounces in five days ; and from a few, a 
much larger quantity. Mr. Gribble, cedar-cooper, in 
Front-street, lost by ten bleedings a hundred ounces of 
blood ; Mr. George, a carter in Ninth-street, lost about the 
same quantity by five bleedings ; and Mr. Peter Mierken, 
one hundred and fourteen ounces in five days. In the last of the 
above persons the quantity taken was determined by weight. 
Mr. Toy, blacksmith near Dock-street, was eight times 
bled in the course of seven days. The quantity taken from 
him was about a hundred ounces. The blood in all these 
cases was dense, and in the last very sizy. They were all 
attended in the month of October, and chiefly by my pupil, 
Mr. Fisher ; and they were all, years afterwards, living and 
healthy instances of the efficacy of copious blood-letting, 
and of the intrepidity and judgment of their young physi- 
cian. Children, and even old people, bore the loss of much 
more blood in this fever than in common inflammatory 
fevers. I took above thirty ounces in five bleedings, from 
a daughter of Mr. Robert Bridges, who was then in the 
9th year of her age. Even great debility, whether natural 
or brought on by previous diseases, did not, in those few 
cases in which it yielded to the fever, deprive it of the 
uniformity of its inflammatory character. The following 
•letter from Dr. Griffitts, written soon after his recovery 
from a third attack of the fever, and just before he went 
into the country for the re-establishment of his health, will 
furnish a striking illustration of the truth of the above 
observation. 

" I cannot leave town without a parting adieu to my 
kind friend, and sincere prayers for his preservation. 

" I am sorry to find that the use of the lancet is still so 
much dreaded by too many of our physicians ; and, while 
lamenting the death of a valuable friend this morning, I 
was told that he was bled but once during his disease. 
Now if my poor frame, reduced by previous sickness, great 
anxiety, and fatigue, and a very low diet, could bear seven 
bleedings, in five days, besides purging, and no diet but 
toast and water, what shall we say of physicians who bleed 
but once ? 

« October 19th, 1793." 

I have compared a paroxysm of this fever to a sudden 
squall ; but the disease in its whole course was like a 



BILIOUS YELLOW FEVER OF 1793. 149 

tedious equinoctial gale acting upon a ship at sea ; its de- 
structive force was only to be opposed by handing every 
sail, and leaving the system to float, as it were under bare 
poles. So great was the fragility (if I may be allowed the 
expression) of the blood-vessels, that it was necessary to 
unload them of their contents, in order to prevent the system 
sinking from haemorrhages, or from effusions in the viscera, 
particularly the brain. 

9. Such was the indomitable nature of the pulse, in some 
patients, that it did not lose its force after numerous and 
copious bleedings. In all such cases I considered the dimi- 
nution of its frequency, and the absence of a vomiting, as 
signals to lay aside the lancet. The continuance of this 
preternatural force in the pulse appeared to be owing to the 
miasmata, which were universally diffused in the air, acting 
upon the arterial system in the same manner that it did in 
persons who were in apparent good health. 

Thus have I mentioned the principal circumstances which 
were connected with blood-letting in the cure of the yellow 
fever. I shall now consider the objections that were made 
to it at the time, and since the prevalence of the fever. 

It was said that the bleeding was unnecessarily copious; 
and that many had been destroyed by it. To this I answer, 
that I did not lose a single patient whom I bled seven times 
or more in this fever. As a further proof that I did not 
draw an ounce of blood too much it will only be necessary 
to add, that haemorrhages frequently occurred altera third, 
a fourth, and in one instance (in the only son of Mr. 
William Hall) after a sixth bleeding had been used ; and 
further, that not a single death occurred from natural 
haemorrhages in the first stage of the disease. A woman, 
who had been bled by my advice, awoke the night follow- 
ing in a bath of her blood, which had flowed from the 
orifice in her arm. The next day she was free from pain 
and fever. There were many recoveries in the city from 
similar accidents. There were likewise some recoveries 
from copious natural haemorrhages in the more advanced 
stages of the disease, particularly when they occurred from 
the stomach and bowels. I left a servant maid of Mrs. 
Morris's in Walnut-street, who had discharged at least four 
pounds of blood from her stomach, without a pulse, and 
with scarcely a symptom that encouraged a hope of her 



150 AN ACCOUNT OF THE 

life ; but the next day I had the pleasure of finding her out 
of danger. 

It was remarked that fainting was much less common 
after bleeding in this fever than in common inflammatory 
fevers. This circumstance was observed by Dr. Griffitts, 
as well as myself. It has since been confirmed to me by 
three of the principal bleeders in the city, who performed 
the operation upwards of four thousand times. It occurred 
chiefly in those cases where it was used for the first time on 
the third or fourth day of the disease. A swelling of the 
legs, moreover, so common after a plentiful bleeding in 
pneumony and rheumatism, rarely succeeded the use of 
this remedy in the yellow fever. 

2. Many of the indispositions, and much of the subse- 
quent weakness of persons who had been cured by copious 
blood-letting, have been ascribed to it. This is so far from 
being true that the reverse of it has occurred in many cases. 
Mr. Mierken worked in his sugar-house in good health, 
nine days after his last bleeding ; and Mr. Gribble and Mr. 
George seemed to have derived fresh vigour from their 
evacuations. I could mention the names of many people 
who assured me their constitutions had been improved by 
the use of those remedies ; and I know several persons in 
whom they have carried off habitual complaints. Mr. 
Richard Wells attributed his reliel from a chronic rheuma- 
tism to the copious bleeding and purging which were used 
to cure him of the yellow fever ; and Mr. William Young, 
the bookseller, was relieved of a chronic pain in his side, 
by means of the same remedies. 

3. It was said, that blood-letting was prescribed indis- 
criminately in all cases, without any regard to age, consti- 
tution, or the force of the disease. This is not true, as far 
as it relates to my practice. In my prescriptions for patients 
whom I was unable to visit, I advised them, when they 
were incapable of judging of the state of the pulse, to be 
guided in the use of bleeding, by the degrees of pain they 
felt, particularly in the head ; and I seldom advised it for 
the first time, after the second or third day of the disease. 

In pneumonies which affect whole neighbourhoods in 
the spring of the year, bleeding is the universal remedy. 
Why should it not be equally so, in a fever which is of a 
more uniform inflammatory nature, and which tends more 



BILIOUS YELLOW FEVER OF 1793. 151 

rapidly to effusions, in parts of the body much more vital 
than the lungs ? 

I have before remarked, that the debility which occurs 
in the beginning of the yellow fever, arises from a depres- 
sed state of the system. The debility in the plague is of 
the same nature. It has long been known that debility 
from the sudden abstraction of stimuli is to be removed by 
the gradual application of stimuli, but it has been less 
observed, that the excess of stimulus in the system is best 
removed in a gradual manner, and that too in proportion to 
the degrees of depression, which exist in the system. 

This principle in the animal economy has been acknow- 
ledged by the practice of occasionally stopping the dis- 
charge of water from a canula in tapping, and of blood 
from a vein, in order to prevent fainting. 

Child-birth induces fainting, and sometimes death, only 
by the sudden abstraction of the stimulus of distention and 
pain. 

In all those cases where purging or bleeding have produ- 
ced death in the yellow fever or plague, when they have 
been used on the first or second day of those diseases, I 
suspect that it was occasioned by the quantity of the stimu- 
lus abstracted being disproportioned to the degrees of 
depression in the system. The following facts will I hope 
throw light upon this subject. 

1. Dr. Hodges informs us, that " although blood could 
not be drawn in the plague, even in the smallest quantity 
without danger, yet a hundred times the quantity of fluids 
was discharged in pus from buboes without inconveni- 
ence."* 

2. Pareus, after condemning bleeding in the plague, 
immediately adds an account of a patient, who was saved 
by a haemorrhage from the nose, which continued two 
days.f 

3. I have before taken notice that bleeding proved fatal 
in three cases in the yellow fever, in the month of August; 
but at that time I saw one, and heard of another case, in 
which death seemed to have been prevented by a bleeding 
at the nose. Perhaps the uniform good effects which were 
observed to follow a spontaneous haemorrhage from an 
©rifiee in the arm, arose wholly from the gradual manner 

* Pape 114, r Skenkius, lib. vi. p. 881. 



152 AN ACCOUNT OF THE 

in which the stimulus of the blood was in this way ab- 
stracted from the body. Dr. Williams relates a case of 
the recovery of a gentleman from the yellow fever, by 
means of small haemorrhages, which continued three days; 
from wounds in his shoulders made by being cupped. He 
likewise mentions several other recoveries by haemorrhages 
from the nose, after " a vomiting of black humours and a 
hiccup had taken place."* 

4. There is a disease in North-Carolina, known among 
the common people by the name of the " pleurisy in the 
head." It occurs in the winter, after a sickly autumn, and 
seems to be an evanescent symptom of a bilious remitting 
fever. The cure of it has been attempted by bleeding, in 
the common way, but generally without success. It has, 
however, yielded to this remedy in another form, that is, 
to the discharge of a few ounces of blood obtained by 
thrusting a piece of quill up the nose. 

5. Riverius describes a pestilential fever which prevailed 
at Montpellier, in the year 1623, which carried oft' one half 
of all who were affected by it.f After many unsuccessful 
attempts to cure it, this judicious physician prescribed the 
loss of two or three ounces of blood. The pulse rose with 
this small evacuation. Three or four hours afterwards he 
drew six ounces of blood from his patients, and with the 
same good effect. The next day he gave a purge, which, 
he says, rescued his patients from the grave. All whom 
he treated in this manner recovered. The whole history 
of this epidemic is highly interesting, from its agreeing 
with our late epidemic in so many of its symptoms, more 
especially as they appeared in the different states of the 
pulse. 

An old and intelligent citizen of Philadelphia, who re- 
members the yellow fever of 1741, says that when it first 
made its appearance bleeding was attended with fatal con- 
sequences. It was laid aside afterwards, and the disease 
prevailed with great mortality until it was checked by the 
cold weather. Had blood been drawn in the manner men- 
tioned by Riverius, or had it been drawn in the usual way, 
after the abstraction of the stimulus of heat by the cool 
weather, the disease might probably have been subdued. 

* Essay on the Bilious or yellow Fever of Jamaica, p. 40 
j De Febre Pestilenti, vol. ii. p. 145, 146, and 147. 



BILIOUS YELLOW FEVER OF 1793. 153 

and the remedy of blood-letting thereby have recovered 
its character. 

Dr. Hodges has another remark, in his account of the 
plague in London in the year 1665, which is stiil more to 
our purpose than the one which I have quoted from it 
upon this subject. He says that " bleeding, as a preven- 
tive ol the plague, was only sale and useful when the blood 
was drawn by a small orifice, and a small quantity taken at 
different times."* 

1 have remarked, in the history of this fever, that it was 
often cured on the first or second day by a copious sweat. 
The Rev. Mr. Ustick was one among many whom I could 
mention, who were saved from a violent attack of the fever 
by this evacuation. It would be absurd to suppose that 
the miasmata which produced the disease were discharged 
in this manner from the body. The sweat seemed to cure 
the fever only by lessening the quantity of the fluids, and 
thus gradually removing the depression of the system. 
The profuse sweats which sometimes cure the plague, as 
well as the disease, which is brought on by the bite of 
poisonous snakes, seem to act in the same way. 

The system, in certain states of malignant fever, resem- 
bles a man struggling beneath a load of two hundred 
weight, who is able to lift but one hundred and seventy-five. 
In order to assist him it will be to no purpose to attempt 
to infuse additional vigour into his muscles by the use of a 
whip or of strong drink. Every exertion will serve only 
to waste his strength. In this situation (supposing it im- 
possible to divide the weight which confines him to the 
ground) let the pockets of this man be emptied of their 
contents, and let him be stripped of so much of his clo- 
thing as to reduce his weight five and twenty or thirty 
pounds. In this situation he will rise from trie ground ; 
but if the weights be abstracted suddenly, while he is in 
an act of exertion, he will rise with a spring that will en- 
danger a second fall, and probably produce a temporary 
convulsion in his system. By abstracting the weights 
from his body more gradually, he will rise by degrees from 
the ground, and the system will accommodate itself in such 
a manner to the diminution of its pressure, as to resume 

* Page 209. 
VOL. III. U 



154 AN ACCOUNT 0¥ THE 

its erect form, without the least deviation from the natural 
order of its appearance and motions. 

It has been said that the stimulating remedies of bark, 
wine, and the cold bath, were proper in our late epidemic 
in August, and in the beginning of September, but that 
they were improper afterwards. If my theory be just, 
they were more improper in August and the beginning of 
September, than they were after the disease put on the out- 
ward and common signs of inflammatory diathesis. The 
reason why a few strong purges cured the disease at its 
first appearance, was, because they abstracted in a gradual 
manner some of the immense portion of stimulus under 
which the arterial system laboured, and thus gradually re- 
lieved it from its low and weakening degrees of depression. 

Bleeding was fatal in these cases, probably because it 
removed this depression in too sudden a manner. 

The principle of the gradual abstraction, as well as of 
the gradual application of stimuli to the body, opens a wide 
field for the improvement of medicine. Perhaps all the 
discoveries of future ages will consist more in a new ap- 
plication of established principles, and in new modes of 
exhibiting old medicines, than in the discovery of new 
theories, or of new articles of the materia medica. 

The reasons which induced me to prescribe purging and 
bleeding, in so liberal a manner, naturally led me to recom- 
mend cool and Jresh air to my patients. The good effects 
of it were obvious in almost every case in which it was 
applied. It was equally proper whether the arterial system 
was depressed, or whether it discovered, in the pulse, a 
high degree of morbid excitement. Dr. Griffitts furnished 
a remarkable instance of the influence of cool air upon the 
fever. Upon my visiting him, on the morning of the 8th 
of October, I found his pulse so full and tense as to indi- 
cate bleeding, but after sitting a few minutes by his bed- 
side, I perceived that the windows of his room had been 
shut in the night by his nurse, on account of the coldness 
of the night air. I desired that they might be opened. In 
ten minutes afterwards the doctor's pulse became so much 
slower and weaker that I advised the postponement of the 
bleeding, and recommended a purge instead of it. The 
bleeding notwithstanding became necessary, and was used 
with great advantage in the afternoon of the same day. 



BILIOUS YELLOW FEVER OF 1793. 155 

The cool air was improper only in those cases where a 
chilliness attended the disease. 

For the same reason that I advised cool air, I directed 
my patients to use cold drinks. They consisted of lemon- 
ade, tamarind, jelly and raw apple water, toast and water, 
and of weak balm, and camomile tea. The subacid drinks 
were preferred in most cases, as being not only most 
agreeable to the taste, but because they tended to com- 
pose the stomach. All these drinks were taken in the early 
stage of the disease. Towards the close of it, I permitted 
the use of porter and water, weak punch, and when the 
stomach would bear it, weak wine-whey. 

I forbade all cordial and stimulating food in the active 
state of the arterial system. The less my patients ate, of 
even the mildest vegetable food, the sooner they recovered. 
Weak coffee, which (as I have formerly remarked) was 
almost universally agreeable, and weak tea were always in- 
offensive. As the action of the pulse diminished, I in- 
dulged my patients with weak chocolate ; also with milk, 
to which roasted apples or minced peaches, and (where they 
were not to be had), bread or Indian mush, were added. 

Towards the crisis, I advised the drinking of weak 
chicken, veal, or mutton broth, and after the crisis had 
taken place, I permitted mild animal food to be eaten in a 
small quantity, and to be increased according to the waste 
of the excitability of the system. This strict abstinence 
which I imposed upon my patients did not escape obloquy ; 
but the benefits they derived from it, and the ill effects 
which arose in many cases from a contrary regimen, satis- 
fied me that it was proper in every case in which it was 
prescribed. 

Cold water was a most agreeable and powerful remedy 
in this disease. I directed it to be applied by means of 
napkins to the head, and to be injected into the bowels by 
way of clyster. It gave the same ease to both, when in 
pain, which opium gives to pain from other causes. I 
likewise advised the washing of the face and hands, and 
sometimes the feet, with cold water, and always with ad- 
vantage. It was by suffering the body to lie for some time 
in a bed of cold water, that the inhabitants of the island of 
Massuah cured the most violent bilious fevers.* When 
* Rruce's Travels. 



156 AN ACCOUNT OF THE 

applied in this way, it gradually abstracts the heat from the 
body, and thereby lessens the action of the system. It differs 
as much in its effects upon the body from the cold bath, as 
rest in a cold room, differs from exercise in the cold and 
open air. 

I was first led to the practice of the partial application of 
cold water to the body, in fevers of too much force in the 
arterial system, by observing its good effects in active 
haemorrhages, and by recollecting the effects of a partial 
application of warm water to the feet, in fevers of an oppo- 
site character. Cold water when applied to the feet as 
certainly reduces the pulse in force and frequency, as warm 
water, applied in the same way, produces contrary effects 
upon it. In an experiment which was made at my 
request, by one of my pupils, by placing his feet in cold 
pump water for a few minutes, the pulse was reduced 24 
strokes in a minute, and became so small as hardly to be t 
perceptible. 

But this effect of cold water, in reducing the frequency 
of the pulse, is not uniform. In weak and irritable habits, 
it increases its frequency. This has been fully proved by 
a number of experiments, made by my former pupil, Dr. 
Stock, of Bristol, in England, and published in his " Me- 
dical Collections of the Effects of Cold, as a Remedy is 
certain Diseases.""* 

In the use of the remedies which were necessary to over- 
come the inflammatory action of the system, I was obliged 
to reduce it below its natural point of excitement. In the 
present imperfect state of our knowledge in. medicine, 
perhaps no disease of too much action can be cured with- 
out it. 

Besides the remedies which have been mentioned, I was 
led to employ another of great efficacy. I had observed a 
favourable issue of the fever, in every case in which a 
spontaneous discharge took place from the salivary glands. 
I had observed further, that all such of my patients (one 
excepted) as were salivated by the mercurial purges reco- 
vered in a few days. This early suggested an idea to me 
that the calomel might be applied to other purposes than 
the discharging of bile from the bowels. I ascribed its 
salutary effects, when it salivated in the first stage of the 

* Page 185. 



BILIOUS YELLOW FEVER OF 1798. 157 

disease, to the excitement of inflammation and effusion in 
the ; hroat, diverting them from more vital parts of the body. 
In the second stage of the disease, I was led to prescribe it 
as a stimulant, and, with a view of obtaining this operation 
from it, I aimed at exciting a salivation, as speedily as 
as possible, in all cases. Two precedents encouraged me 
to make trial of this remedy. 

In the month of October, 1789, I attended a gentleman 
in a bilious fever, which ended in many of the symptoms 
of a typhus mitior. In the lowest state of his fever, he 
complained of a pain in his right side, for which I ordered 
half an ounce of mercurial ointment to be rubbed on the 
part affected. The next day, he complained of a sore 
mouth, and, in the course of four and twenty hours, he was 
in a moderate salivation. From this time his pulse became 
full and slow, and his skin moist ; his sleep and appetite 
suddenly returned, and in a day or two he was out of 
danger. The second precedent for salivation in a fever, 
which occurred to me, was in Dr. Haller's short account 
of the works of Dr. Cramer. * The practice was moreover 
justified, in point of safety, as well as the probability of 
success, by the accounts which Dr. Clark has lately given 
of the effects of a salivation in the dysentery, f I began by 
prescribing the calomel in small doses, at short intervals, 
and afterwards I directed large quantities of the ointment 
to be rubbed upon the limbs. The effects of it, in every 
case in which it affected the mouth, were salutary. Dr. 
Woodhouse improved upon my method of exciting the 
salivation,, by rubbing the gums with calomel, in the man. 
ncr directed by Mr. Clare. It was more speedy in its 
operation in this way than in any other, and equally effectual. 
Several persons appeared to be benefitted by the mercury 
introduced into the system in the form of an ointment, 
where it did not produce a salivation. Among these, were 
the Rev. Dr. Black well, and Mr. John Davis. 

Soon after the above account was written of the good 
effejets of a mercurial salivation in this fever, I had great 
satisfaction in discovering that it had been prescribed with 
equal, and even greater success, by Dr. Wade in Bengal, 
in the year 1791, and by Dr. Chisholm in the island of 

* Bibliotheca Medicinx Practicx, vol. iii. p. 491. 

i diseases of Long Voyages to Hot Climates, vol. li . p. 334. 



158 AN ACCOUNT OF THE 

Granada, in the cure of bilious yellow fevers.* Dr. Wade 
did not lose one, and Dr. Chisholm lost only one out of 
forty-eight patients in whom the mercury affected the sali- 
vary glands. The latter gave 150 grains of calomel, and 
applied the strongest mercurial ointment below the groin 
of each side, in some cases. He adds further, that not a 
single instance of a relapse occurred, where the disease was 
cured by salivation. 

After the reduction of the system, blisters were applied 
with great advantage to every part of the body. They did 
most service when they were applied to the crown of the 
head. I did not see a single case, in which a mortification 
followed the sore, w r hich was created by a blister. 

Brandy and water, or porter and water, when agreeable 
to the stomach, with now and then a cup of chicken broth, 
were the drinks I prescribed to assist in restoring the tone 
of the system. 

In some cases I directed the limbs to be wrapped in 
flannels dipped in warm spirits, and cataplasms of bruised 
garlic to be applied to the feet. But my principal depen- 
dence, next to the use of mercurial medicines, for exciting 
a healthy action in the arterial system, was upon mild and 
gently stimulating food. This consisted of rich broths, 
the flesh of poultry, oysters, thick gruel, mush and milk, 
and chocolate. I directed my patients to eat or drink a 
portion of some of the above articles of diet every hour or 
two during the day, and in cases of great debility, from an 
exhausted state of the system, I advised their being waked 
for the same purpose two or three times in the night. The 
appetite frequently craved more savoury articles of food, 
such as beef-stakes and sausages ; but they were permitted 
with great caution, and never till the system had been prepar- 
ed for them by a less stimulating diet. 

There were several symptoms which were very dis- 
distressing in this disease, and which required a specific 
treatment. 

For the vomiting, with a burning sensation in the sto- 
mach, which came on about the fifth day, I found no 
remedy equal to a table spoonful of sweet milk, taken every 
hour, or to small draughts of milk and water. I was led 
to prescribe this simple medicine from having heard, from 
* Medical Commentaries, vol. xviii. p. 209, 288. 



BILIOUS YELLOW FEVER OF 1793. 159 

a West- India practitioner, and afterwards read, in Dr. 
Hume's account of the yellow fever, encomiums upon the 
milk of the cocoa-nut for this troublesome symptom. 
Where sweet milk failed of giving relief, 1 prescribed small 
doses of sweet oil, and in some cases a mixture of equal 
parts of milk, sweet oil, and molasses. They were all 
intended to dilute or blunt the acrimony of the humours, 
which were either effused or generated in the stomach. 
Where they all failed of checking the vomiting, I prescrib- 
ed weak camomile tea, or porter, or cyder and water, with 
advantage. In some of my patients the stomach rejected 
all the mixtures and liquors which have been mentioned. 
In such cases I directed the stomach to be left to itself for 
a lew hours, after which it sometimes received and retain- 
ed the drinks that it had before rejected, provided they were 
administered in a small quantity at a time. 

The vomiting was sometimes stopped by a blister ap- 
plied to the external region of the stomach. 

A mixture of liquid laudanum and sweet oil, applied 
to the same plaec, gave relief where the stomach was af- 
fected by pain only, without a vomiting. 

I have formerly mentioned that a distressing pain often 
seized the lower part of the boxvels. I was early taught 
that laudanum was not a proper remedy for it. It yielded 
in almost every case to two or three emollient clysters, or 
to the loss of a few ounces of blood. 

The convalescence from this lever was in general rapid, 
but in some cases it was very slow. I was more than 
usually struck by the great resemblance which the system 
in the convalescence from this fever bore to the state of the 
body and mind in old age. It appeared, 1. In the great 
weakness of the body, more especially of the limbs. 2. 
In uncommon depression of mind, and in a great aptitude 
to shed tears. 3. In the absence or short continuance of 
sleep. 4. In the frequent occurrence of appetite, and, in 
some cases, in its inordinate degrees. And 5. In the loss 
of the hair of the head, or in its being suddenly changed 
in some cases to a gray colour. 

Pure air, gentle exercise, and agreeable society removed 
the debility both of body and mind of this premature and 
temporary old age. I met with a few cases, in which the 
yellow colour continued for several weeks after the patient's 



160 AN ACCOUNT OF THfl 

recovery from all the other symptoms of the fever. It was 
removed most speedily and effectually by two or three mo- 
derate doses of calomel and rheubarb. 

A feeble and irregular intermittent was very troublesome 
in some people, after an acute attack of the fever. It 
yielded gradually to camomile or snake-root tea and coun- 
try air. 

In a publication, dated the 16th of September, I recom- 
mended a diet of milk and vegetables, and cooling purges 
to be taken once or twice a week, to the citizens of Phila- 
delphia. This advice was the result of the theory of the 
disease I had adopted, and of the successful practice which 
had arisen from it. In my intercourse with my fellow, 
citizens, I advised this regimen to be regulated by the de- 
grees of fatigue and foul air to which they were exposed. 
I likewise advised moderate iDlood-letting to all such per- 
sons as were of a plethoric habit. To men whose minds 
were influenced by the publications in favour of bark and 
wine, and who were unable at that time to grasp the extent 
and force of the remote cause of this terrible fever, the 
idea of dieting, purging, or bleeding the inhabitants of a 
whole village or city appeared to be extravagant and ab- 
surd : but I had not only the analogy of the regimen made 
use of to prepare the body for the small-pox, but many 
precedents in favour of the advice. Dr. Haller has given 
extracts from the histories of two plagues, in which the 
action of the miasmata was prevented or mitigated by 
bleeding.* Dr. Hodges confirms the utility of the same 
practice. The benefits of low diet, as a preventive of the 
plague, were established by many authors, long before they 
received the testimony of the benevolent Mr. Howard in 
their favour. Socrates in Athens, and Justinian in Con* 
stantinople, were preserved, by means of their abstemious 
modes of living, from the plagues which occasionally rava- 
ged those cities. By means of the low diet, gentle physic, 
and occasional bleedings, which I thus publicly recom- 
mended, the disease was prevented in many intances, or 
rendered mild where it was taken. But my efforts to pre- 
vent the disease in my fellow-citizens did not end here. 
I advised them, not only in the public papers, but in my 
intercourse with them, to avoid heat, cold, labour, and 

* Bibliotheca Medians Practicx, vol. ii. p. 93, and 387. 



BILIOUS YELLOW FEVER OF 1793. 161 

every thing else that could excite the miasmata (which I 
knew to be present in all their bodies) into action. I for- 
got, upon this occasion, the usual laws which regulate the 
intercourse of man with man. In the streets, and, upon 
the public roads in my excursions into the neighbourhood 
of the city, I cautioned many persons, whom I saw walk- 
ing or riding in an unsafe manner, of the danger to which 
they exposed themselves ; and thereby, I hope, prevented 
an attack of the disease in many people. 

It was from a conviction of the utility of low diet, gentle 
evacuations, and of carefully shunning all the exciting 
causes which I have mentioned, that I concealed, in no 
instance, from my parents the name of their disease. This 
plainness, which was blamed by weak people, produced 
strict obedience to my directions, and thereby restrained 
the progress of the fever in many families, or rendered it, 
when taken, as mild as inoculation does the small-pox. 
The opposite conduct of several physicians, by preventing 
the above precautions, increased the mortality of the dis- 
ease, and, in some instances, contributed to the extinction 
of whole families. 

I proceed now to make a few remarks upon the remedies 
recommended by Doctors Kuhn and Stevens, and by the 
French physicians. The former were bark, wine, lauda- 
num, spices, the elixir of vitriol, and the cold bath. 

In every case in which I prescribed bark, it was offen- 
sive to the stomach. In several tertians whish attended 
the convalescence from a common attack of the fever, I 
found it always unsuccessful, and once hurtful. Mr. Wil- 
ling took it for several weeks without effect. About half 
a pint of a weak decoction of the bark produced, in Mr. 
Samuel Meredith, a paroxysm of the fever, so violent as 
to require the loss of ten ounces of blood to moderate it. 
Dr. Annan informed me that he was forced to bleed one of 
his patients twice, after having given him a small quantity 
of bark, to hasten his convalescence. 

It was not in this epidemic only '.hat the bark was hurt- 
ful. Baron Humboldt informed me that Dr. Comoto had 
assured him, it hastened death in every case in which it 
was given in the yellow fever of Vera Cruz. If, in any 
instance, it was inoffensive, or did sen ice, in our fever, I 
suspect it must have acted upon the bowels as a purge. 

VOL. III. x 



162 AN ACCOUNT OP THE 

Dr. Sydenham says the bark cured intermittents by this 
evacuation ;* and Mr. Bruce says it operated in the same 
way, when it cured the bilious fevers at Massuah. 

JVine was nearly as disagreeable as the bark to the 
stomach, and equally hurtful. I tried it in every form, and 
of every quality. But without success. It was either 
rejected by the stomach, or produced in it a burning sensa- 
tion. I should suspect that I had been mistaken in my 
complaints against wine, had I not since met with an 
account in Shenkius of its having destroyed all who took 
it in the famous Hungarian fever which prevailed, with 
great mortality, over nearly every country in Europe, about 
the middle of the 16th century. \ Dr. Wade de lares wine 
to be " ill adapted to the fevers of Bengal, where the treat- 
ment has been proper in other respects. " 

Laudanum has been called by Dr. Moseley " a fatal 
medicine" in the yellow fever. In one of my patients, wha 
took only fifteen drops of it, without my advice, to ease a 
pain in his bowels, it produced a delirium, and death in a 
few hours. I was much gratified in discovering that my 
practice, with respect to the use of opium in this fever, 
accorded with Dr. Wade's in the fever of Bengal. He tells 
us, " that it was mischievous in almost every instance, 
even in combination with antimonials." 

The spices were hurtful in the first stage of the fever, 
and, when sufficient evacuations had been used, they were 
seldom necessary in its second. 

The elixir of vitriol was, in general, offensive to the 
stomach. 

The cold bath was useful in those cases where its sedative 
prevailed over its stimulating effects. But this could not 
often happen, from the suddenness and force, with which 
the water was thrown upon the body. In two cases in 
which I prescribed it, it produced a gentle sweat, but it 
did not save life. In a third it removed a delirium, and 
reduced the pulse for a few minutes, in frequency and force, 
but this patient died. The recommendation of it indiscri- 
minately, in all cases, was extremely improper. In 
that chilliness and tendency to fainting upon the least 

* Vol i. p. 440. 

f Omnesqui vini potione non abstinuerunt, interiere, ad^o ut summa 
spes salvationis in vini abstinentia collocata videter. Lib. vi. p. 847. 



BILIOUS YELLOW FEVER OF 1793. 163 

motion, which attended the disease in some patients, it was 
an unsafe remedy. 1 heard of a woman who was seized 
with delirium immediately after using it, from which she 
never recovered ; and of a man who died a few minutes 
after he came out of a bathing tub. Had this remedy been 
the exclusive antidote to the yellow fever, the mortality of 
the disease would have been but little checked by it. 
Thousands must have perished from the want of means to 
procure tubs, and of a suitable number of attendants to 
apply the water, and to lift the patient in and out of bed. 
The reason of our citizens ran before the learning of the 
friends of this remedy, and long belore it was abandoned 
by the physicians, it was rejected as useless, or not attempt- 
ed, because impracticable, by the good sense of the city. 
It is to be lamented that the remedy of cold water has 
suffered in its character by the manner in which it was 
advised. In fevers of too much action, it reduces the mor- 
bid excitement of the blood-vessels, provided it be applied 
without force, and for a considerable time, to the body. It 
is in the jail fever, and in the second stage of the yellow fever 
only, in which its stimulant and tonic powers are proper. 
Dr. Jackson establishes this mode of using it, by informing 
us, that when it did service, it " gave vigour and tone" to 
the system.* 

A mode of practice which I formerly mentioned in this 
fever, consisted of a union of the evacuating and tonic 
remedies. The physicians who adopted this mode gave 
calomel by itself, in small doses, on the first or second day 
of the fever, bled once or twice, in a sparing manner, and 
gave the bark, wine, and laudanum, in large quantities, 
upon the first appearance of a remission. After they began 
the use of these remedies purging was omitted, or, if the 
bowels were moved, it was only by means of gentle clys- 
ters. This practice, I shall say hereafter, was not much 
more successful than that which was recommended by Dr. 
Kuhn and Dr. Stevens. It resembled throwing water and 
oil at the same time upon a fire, in order to extinguish it. 

The French remedies were nitre and cremor tartar, in 
small doses, centaury tea, camphor, and several other warm 
medicines ; subacid drinks, taken in large quantities, the 
warm bath, and moderate bleeding. 

• Fevers of Jamaica. 



164 AN ACCOUNT OF THE 

After what has been said it must be obvious to the reader, 
that the nitre and cremor tartar, in small doses, could do 
no good, and that camphor, and all cordial medicines must 
have done harm. The diluting subacid drinks, which the 
French physicians gave in large quantities were useless in 
diluting and blunting the acrimony of the bile, and to this 
remedy, assisted by occasional bleeding, I ascribe most of 
the cures which were performed by those physicians. 

Those few persons in whom the warm bath produced 
copious and universal sweats recovered, but, in nearly all 
the cases which came under my notice, it did harm. 

I come now to inquire into the comparative success of all 
the different modes of practice which have been mentioned. 

I have already said that ten out of thirteen patients whom I 
treated with bar!., wine, and laudanum, and that three out of 
four, in whom I added the cold bath to those remedies, 
died. Dr. Pennington informed me, that he had lost all 
the patients (six in number) to whom he had given the 
above medicines. Dr. Johnson assured me, with great 
concern, about two weeks before he died, that he had not 
recovered a single patient by them. Whole families were 
swept off where these medicines were used. But further, 
most of those persons who received the seeds of the fever 
in the city, and sickened in the country, or in the neigh- 
bouring towns, and who were treated with tonic remedies 
died. There was not a single cure performed by them in 
New- York, where they were used in several sporadic cases 
with every possible advantage. But why do I multiply 
proofs of their deadly effects ? The clamours of hundreds 
whose relations had perished by them, and the fears of 
others, compelled those physicians who had most attached 
to them to lay them aside, or to prepare the way for them 
(as it was called) by purging and bleeding. The bathing 
tub soon shared a worse fate than bark, wine, and lauda- 
num, and, long before the disease disappeared, it was dis- 
carded by all the physicians in the city. 

In answer to these facts we are told, that Mr. Hamilton 
and his family were cured by Dr. Stevens' remedies, and 
that Dr. Kuhn had administered them with success in 
several instances. 

Upon these cures I shall insert the following judicious 
remarks from Dr. Sydenham. " Success (says the doctor) 



BILIOUS YELLOW FEVER OF 1793. 165 

is not a sufficient proof of the excellency of a method of 
cure in acute diseases, since some are recovered by the 
imprudent procedure of old women ; but it is further 
required, that the distemper should be easily cured, and 
yield conformably to its own nature."* And again, speak- 
ing of the cure of the new fever of 1685, this incomparable 
physician observes, " Ii it be objected that this fever fre- 
quently yields to a quite contrary method to that which I 
have laid down, I answer, that the cure of a disease by a 
method which is attended with success only now and then, 
in a few instances, diners extremely from that practical 
method, the efficacy whereof appears both from its recover- 
ing greater numbers, and all the practical phenomena 
happening in the cure."f 

Far be it from me to deny that the depression of the system 
may not be overcome by such stimuli as are more power- 
ful than those which occasion it. This has sometimes been 
demonstrated by the efficacy of bark, wine, and laudanum, in 
the confluent and petechial small-pox ; but even this state 
of that disease yields more easily to blood-letting, or to 
plentiful evacuations from the stomach and bowels, on the 
first or second day of the eruptive fever. This I have often 
proved, by giving a large dose of tartar emetic and calomel, 
as soon as I was satisfied from circumstances, that my 
patient was infected with the small-pox. But the depres- 
sion produced by the yellow fever appears t© be much 
greater than that which occurs in the small-pox, and 
hence it more uniformly resisted the most powerful tonic 
remedies. 

In one of my publications during the prevalence of the 
fever I asserted, that the remedies of which I have given a 
history cured a greater proportion than ninety-nine out of a 
hundred, of all who applied to me on the first day of the 
disease, before the 15th day of September. I regret that 
it is not in my power to furnish a list of them, for a majo- 
rity of them were poor people, whose names are still un- 
known to me. I was not singular in this successful 
practice in the first appearance of the disease. Dr. Pen- 
nington assured me on his death bed, that he had not lost 
one, out of forty-eight patients whom he had treated agree- 
ably to the principles and practice I had recommended. 

* Vol. ii. p. 254. f Vol. ii. p. "54. 



166 AN ACCOUNT OF THE 

Dr. Griffitts triumphed over the disease in every part of 
the city, by the use of what were called the new remedies. 
My former pupils spread, by their success, the reputation 
of purging and bleeding, wherever they were called. Unhap- 
pily the pleasure we derived from this success in the treat- 
ment of the disease, was of short duration. Many circum- 
stances contributed to lessen it, and to revive the mortality 
of the fever. I shall briefly enumerate them. 

1. The distraction produced in the public mind, by the 
recommendation of remedies, the opposites in every resptct 
of purging and bleeding. 

2. The opinion which had been published by several 
physicians, and inculcated by others, that we had other 
fevers in the city besides the yellow fever. This produced 
a delay in many people in sending for a physician, or in 
taking medicines, for two or three days, from a belief that 
they had nothing but a cold, or a common fever. Some 
people were so much deceived by this opinion, that they 
refused to send for physicians, lest they should be infected 
by them with the yellow fever. In most of the cases in 
which these delays took place, the disease proved mortal. 

To obviate a suspicion that I have laid more stress upon 
the fatal influence of this error than is just, I shall here 
insert an extract of a letter I received from Mr. John Con- 
nelly, one of the city committee, who frequently left his 
brethren in the city hall, and spent many hours in visiting 
and prescribing for the sick. " The publications (says he) 
of some physicians, that there were but few persons infected 
with the yellow fever, and that many were ill with colds 
and common remitting and fall fevers, proved fatal to almost 
every family which was credulous enough to believe them. 
That opinion slew its hundreds if not its thousands, many of 
whom did not send for a physician until they were in the last 
stage of the disorder, and beyond the power of medicine." 

3. The interference of the friends of the stimulating 
system, in dissuading patients from submitting to sufficient 
evacuations. 

4. The deceptions which were practised by some patients 
upon their physicians, in their reports of the quantity of 
blood they had lost, or of the quality and number of their 
evacuations by stool. 

5. The impracticability of procuring bleeders as soon as 



BILIOUS YELLOW FEVER OF 1793. 167 

bleeding was prescribed. Life in this disease, as in the 
apoplexy, frequently turned upon that operation being 
performed within .\n hour. It was often delayed, from the 
want of a bleeder, one or two days. 

6. The inability of physicians, from the number of their 
pati'. nts, and from frequent indisposition, to visit the sick, 
at such times as was necessary to watch the changes in 
their disease. 

7. The great accumulation and concentration of the 
miasmata in sick rooms, from the continuance of the disease 
in the city, whereby the system was exposed to a constant 
stimulus, and the effect of the evacuations was thus 
defeated. 

8. The want of skill or fidelity in nurses to administer 
the medicines properly ; to persuade patients to drink fre- 
quently ; also to supply them with food or cordial drinks 
when required in the night. 

9. The great degrees of debility induced in the systems 
of many of the people who were affected by the disease, 
from fatigue in attending their relations or friends. 

10. The universal depression of mind, amounting in 
some instances to dispair, which affected many people. 
What medicine could act upon a patient who awoke in the 
night, and saw through the broken and faint light of a 
candle, no human creature, but a black nurse, perhaps 
asleep in a distant corner of the room ; and who heard no 
noise, but that of a hearse conveying, perhaps, a neighbour 
or a friend to the grave ? The state of mind under which 
many were affected by the disease, is so well described by 
the Rev. Dr. Smith, in the case of his wife, in a letter I 
received from him in my sick room, two days after her 
death, that I hope I shall be excused for inserting an ex- 
tract from it. It forms a part of the history of the disease. 
The letter was written in answer to a short note of condo- 
lence which I sent to the doctor immediately after hearing 
of Mrs. Smith's death. After some pathetic expressions 
of grief, he adds, " The scene of her funeral, and some 
preceding circumstances, can never depart from my mind. 
On her return from a visit to our (laughter, whom we had 
been striving to console on the death of Mrs. Keppele, who 
was long familiar and dear to both, my clear wife, passing 
the burying-ground gate led me into the ground, viewed 



168 AN ACCOUNT OF THE 

the graves of her two children, called the old grave-digger, 
marked a spot for herself as close as possible to ttiem and 
the grave of Dr. Phineas Bond, whose memory slit ado- 
red. Then, by the side of the spot she had chosen, we 
found room and chose ?nine, pledging ourselves to each 
other, and directing the grave-digger, that this should be 
the order of our interment. We returned to our house. 
Night approached. I hoped my dear wife had gone to 
rest, as she had chosen, since her return from nursing her 
daughter, to sleep in a chamber by herself, through fear of 
infecting her grandchild and me. But it seems she closed 
not her eyes ; sitting with them fixed through her chamber 
window on Mrs. Keppele's house, till about midnight she saw 
her hearse, and followed it with her eyes as far as it could 
be seen. Two days afterwards Mrs. Rodgers, her next 
only serviving intimate friend was carried past her window, 
and by no persuasion could I draw her from thence, nor 
stop her sympathetic foreboding tears, so long as her eyes 
could follow the funeral, which was through two squares, 
from Fourth to Second -street, where the hearse disappeared." 
The doctor proceeds in describing the distress of his wife. 
But pointed as his expressions are, they do not convey the 
gloom} state of her mind with so much force as she has 
done it herself in two letters to her niece, Mrs. Cadwalla- 
der, who was then in the country. The one was dated the 
9th, the other the 1 1th of October. I shall insert a few 
extracts from each of them. 

October 9th. "It is not possible for me to pass the 
streets without walking in a line with the dead, passing in- 
fected houses, and looking into open graves. This has 
been the case for many weeks." " I don't know what to 
write ; my head is gone, and my heart is torn to pieces." 
" I entreat you to have no fears on my account. I am in 
the hands of a just and merciful God, and his will he 
done." 

October ll'th. " Don't wonder that I am so low to-day. 
My heart is sunk down within me." 

The next day this excellent woman sickened, and died 
on the 19th of the same month. 

If in a person possessed naturally of uncommon equani- 
mity and fortitude, the distresses of our city produced such 
dejection of spirits, what must have been their effect upon 



BILIOUS YELLOW FEVER OF 1793. 169 

hundreds, who were not endowed with those rare and ex- 
traordinary qualities of mind ! Death in this, as well as in 
many other cases in which medicine had done its duty, 
appeared to be the inevitable consequence of the total ab- 
straction of the energy of the mind in restoring the natural 
motions of life. 

Under all the circumstances which have been mentioned, 
which opposed the system of depletion in the cure of this 
fever, it was still far more successful than any other mode 
of cure that had been pursued before in the United States, 
or in the West-Indies. 

Three out of four died of the disease in Jamaica, under 
the care of Dr. Hume. 

Dr. Blane considers it as one of the " most mortal" of 
diseases, and Dr. Jackson places a more successful mode 
of treating it among the subjects which will admit of 
" innovation" in medicine. 

After the 15th of September, my success was much 
limited, compared with what it had been before that time. 
But at no period of the disease did I lose more than one 
in twenty of those whom I saw on the first day, and at- 
tended regularly through every stage of the fever, provided 
they had not been previously worn down by attending the 
sick. 

The following statement which will admit of being cor- 
rected, if it be inaccurate, will, I hope, establish the truth 
of the above assertions. 

About one half of the families whom I have attended 
for many years, left the city. Of those who remained, 
many were affected by the disease. Out of the whole of 
them, after I had adopted my second mode of practice, I 
lost but five heads of families, and about a dozen servants 
and children. In no instance did I lose both heads of the 
same family. My success in these cases was owing to 
two causes : 1st, To the credit my former patients gave to 
my public declaration, that we had only one fever in the 
city : hence they applied on the first day, and sometimes 
on the first hour of their indisposition ; and 2dly, To the 
numerous pledges many of them had seen of the safety 
and efficacy of copious blood-letting, by my advice, in 
other diseases : hence my prescription of that necessary 
remedy was always obeyed in its utmost extent. Of the 

VOL. III. y 



170 AN ACCOUNT Of THE 

few adults whom I lost, among my former patients, two of 
them were old people, two took laudanum, without rny 
knowledge, and one refused to take medicine of any kind; 
all the rest had been worn down by previous fatigue. 

I have before said that a great number of the blacks 
were my patients. Of these not one died under my care. 
This uniform success, among those people, was not owing 
altogether to the mildness of the disease, for I shall say 
presently, that a great proportion of a given number died, 
under other modes of practice. 

In speaking of the comparative effects of purging and 
bleeding, it may not be amiss to repeat, that not one preg- 
nant woman, to whom I prescribed them, died or suffered 
abortion. Where the tonic remedies were used, abortion 
or death, and, in many instances, both, were nearly uni- 
versal. 

Many whole families, consisting of five, six, and, in 
three instances, of nine members, were recovered by plenti- 
ful purging and bleeding. I could swell this work, by 
publishing a list of those families ; but I take more plea- 
sure in adding, that I was not singular in my success in 
the use of the above remedies. They were prescribed 
with great advantage by many of the physicians of the 
city, who had for a while given tonic medicines without 
effect. I shall not mention the names of any of the phy- 
sicians who totally renounced those medicines, lest I should 
give offence by not mentioning them all. Many large 
families were cured by some of them, after they adopted 
and prescribed copious purging and blood-letting. One 
of them cured ten in the family of Mr. Robert Hay dock, 
by means of those remedies. In one of that family, the 
disease came on with a vomiting of black bile. 

But the use of the new remedies was not directed finally 
by the physicians alone. The clergy, the apothecaries, 
many private citizens, several intelligent women, and two 
black men, prescribed them with great success. Nay more, 
many persons prescribed them to themselves, and, as I 
shall say hereafter, with a success that was unequalled by 
any of the regular or irregular practitioners in the city. 

It was owing to the almost universal use of purging and 
bleeding, that the mortality of the disease diminished, in 
proportion as the number of persons who were affected by 



BILIOUS YELLOW FEVER OF 1793. 171 

it increased. About the middle of October, it was scarcely 
double of what it was in the middle of September, and 
yet six times the number of persons were probably at that 
time confined by it. 

The success of copious purging and bleeding was not 
confined to the city of Philadelphia. Several persons, who 
were infected in town, and sickened in the country, were 
cured by them. 

Could a comparison be made of the number of patients 
who died of the yellow fever in 1793, after having been 
plentifully bled and purged, with those who died of the 
same disease in the years 1699, 1741, 1747, and 1762, I 
am persuaded that the proportion would be very small in 
the year 1793, compared with the former years.* Includ- 
ing all who died under every mode of treatment, I suspect 
the mortality to be less, in proportion to the population of 
the city, and the number of persons who were affected than 
it was in any of the other years that have been mentioned. 

Not less than 6000 of "the inhabitants of Philadelphia 
probably owe their lives to purging and bleeding, during 
the autumn. 

I proceed with reluctance to inquire into the comparative 
success of the French practice. It would not be difficult 
to decide upon it from many facts that came under my 
notice in the city ; but I shall rest its merit wholly upon 
the returns of the number of deaths at Bush-hill. This 
hospital, after the 22d of September, was put under the 
care of a French physician, who was assisted by one of the 
physicians of the city. The hospital was in a pleasant and 
airy situation ; it was provided with all the necessaries and 
comforts for sick people that humanity could invent, or 
liberality supply. The attendants were devoted to their 
duty ; and cleanliness and order pervaded every room in 
the house. The reputation of this hospital, and of the 
French physician, drew patients to it in the early state of 
the disease. Of this I have been assured in a letter from 
Dr. Annan, who was appointed to examine and give orders 
of admission into the hospital, to such of the poor of the 

* It appears from one of Mr. Norris's letters, dated the 9th of Novem- 
ber, (). S that there died 220 px rsons, in the year 1699, with the yellow 
Between .SO and 90 of (hem, he says, belonged to the society of 
Is, The city, at this time, probably, did not contain more than 2 or 
3000 people, many of whom, it is probable, fled from the disease. 



172 AN ACCOUNT OF »TH£ 

district of Southwark, as could be taken care of in their 
own houses. Mr. Olden has likewise informed me, that 
most of the patients who were sent to the hospital by the 
city committee (of which he was a member) were in the 
first stage of the fever. With all these advantages, the 
deaths between the 22d of September and the 6th of No- 
vember, amounted to 448 out of 807 patients who were 
admitted into the hospital within that time. Three fourths 
of all the blacks (nearly 20) who were patients in this 
hospital died. A list of the medicines prescribed there may 
be seen in the minutes of the proceedings of the city com- 
mittee. Calomel and jalap are not among them. Moderate 
bleeding and purging with glauber's salts, I have been 
informed, were used in some cases by the physicians of 
this hospital. The proportion of deaths to the recoveries, 
as it appears in the minutes of the committee from whence 
the above report is taken, is truly melancholy ! I hasten 
from it therefore to a part of this work, to which I have 
looked with pleasure, ever since I sat down to compose it. 
I have said that the clergy, the apothecaries, and many 
other persons who were uninstructed in the principles of 
medicine, prescribed purging and bleeding with great 
success in this disease. Necessity gave rise to this undis- 
ciplined sect of practitioners, for they came forward to 
supply the places of the regular bred physicians who were 
sick or dead. I shall mention the names of a few of those 
persons who distinguished themselves as volunteers in this 
new work of humanity. The late Rev. Mr. Fleming, one 
of the ministers of the catholic church, carried the purging 
powders in his pocket, and gave them to his poor parish- 
ioners with great success. He even became the advocate 
of the new remedies. In a conversation I had with him, 
on the 22d of September, he informed me, that he had 
advised four of our physicians, whom he met a day or two 
before, " to renounce the pride of science, and to adopt 
the new mode of practice, for that he had witnessed its 
good effects in many cases." Mr. John Kcihmle, a German 
apothecary, has assured me, that out of 314 patients whom 
he visited, and 187 for whom he prescribed from the 
reports of their friends, he lost but 47 (which is nearly but 
one in eleven,) and that he treated them all agreeably 
to the method which I had recommended. The Rev. Mr. 



BILIOUS YEILOW FEVER OP 1793. 173 

Schmidt, one of the ministers of the Lutheran church, was 
cured by him. I have before mentioned an instance of the 
judgment of Mr. Connelly, and of his zeal in visiting and 
prescribing for the sick. His remedies were bleeding and 
purging. He, moreover, bore a constant and useful testi- 
mony against bark, wine, laudanum, and the warm bath.* 
Mrs. Paxton, in Carter's alley, and Mrs. Evans, the wife 
of Mr. John Evans, in Second-street, were indefatigable ; 
the one in distributing mercurial purges composed by 
herself, and the other in urging the necessity of copious 
bleeding and purging among her friends and neighbours, 
as the only safe remedies for the fever. These worthy 
women were the means of saving many lives. f Absalom 
Jones and Richard Allen, two black men, spent all the inter- 
vals of time, in which they were not employed in burying the 
dead, in visiting the poor who were sick, and in bleeding and 
purging them, agreeably to the directions which had been 
printed in all the newspapers. Their success was unparal- 
leled by what is called regular practice. This encomium 
upon the practice of the blacks will not surprise the reader, 
when I add that they had no fear of putrefaction in the 
fluids, nor of the calumnies of a body of their fellow-citizens 
in the republic of medicine to deter them from plentiful 
purging and bleeding. They had, besides, no more patients 
than they were able to visit two or three times a day. But 
great as their success was, it was exceeded by those persons 
who, in dispair of procuring medical aid of any kind, 
purged and bled themselves. This palm of superior success 

* In the letter before quoted, from Mr. Connelly, he expresses his 
opinion of those four medicines in the following words: M Laudanum, bark, 
and wine have put a period to the existence of some where the fever has 
been apparently broken, and the patients in a fair way of recovery; a single 
dose ot laudanum has hurried them suddenly into eternity- I have visited 
a few patients where the hot bath was used, and am convinced that it only 
tended to weaken and relax the system, without producing any good 
effect" 

f The yellow fever prevailed at the Caraccos, in South-America, in 
October, 1793, with great mortality, more especially among the Spanish 
tr * ps. Nearly all died who ware attended by physicians. Recourse was 
finally had to the old women, who were successful in almost every case to 
which they were called. Their remedies were a liquor called narencado 
(a species of lemonade) and a tea made of a root called^?*'«/a. With these 
drinks they drenched their patients for the first two or three days. They 
induced plentiful sweats, and, probably, after blunting, discharged the bile 
from the bowels. I received this information from an American gentleman, 
who had been cured, by one of those Amazons in medicine, in the above 
way. 



174 AN ACCOUNT OF THE 

will not be withheld from those people when I explain the 
causes of it. It was owing to their early use of the proper 
remedies, and to their being guided in the repetition of 
them, by the continuance of a tense pulse, or of pain and 
fever. A day, an afternoon, and even an hour, were not 
lost by these people in waiting for the visit of a physician, 
who was often detained from them by sickness, or by new 
and unexpected engagements, by which means the precious 
moment for using the remedies with effect passed irrevoca- 
bly away. I have stated these facts from faithful inquiries, 
and numerous observations. I could mention the names 
and families of many persons who thus cured themselves. 
One person only shall be mentioned, who has shown by 
her conduct what reason is capable of doing when it is 
forced to act for itself. Mrs. Long, a widow, after having 
been twice unsuccessful in her attempts to procure a phy- 
sician, undertook at last to cure herself. She took several 
of the mercurial purges, agreeably to the printed directions, 
and had herself bled seven times in the course of five or 
six days. The indication for repeating the bleeding was 
the continuance of the pain in her head. Her recovery was 
rapid and complete. The history of it was communicated 
to me by herself, with great gratitude, in my own house, 
during my second confinement with the fever. To these 
accounts of persons who cured themselves in the city, I 
could add many others, of citizens who sickened in the 
country, and who cured themselves by plentiful bleeding 
and purging, without the attendance of a physician. 

From a short review of these facts, reason and humanity 
awake from their long repose in medicine, and unite in 
proclaiming, that it is time to take the cure of pestilential 
epidemics out of the hands of physicians, and to place it in 
the hands of the people. Let not the reader startle at this 
proposition. I shall give the following reasons for it. 

1. In consequence of these diseases affecting a number 
of people at one time, it has always been, and always will 
be impossible, for them all to have the benefit of medical 
aid, more especially as the proportion of physicians to the 
number of sick, is generally diminished upon these occa- 
sions, by desertion, sickness, and death. 

2. The safety of committing to the people the cure of 
pestilential fevers, particularly the yellow fever and the 



BILIOUS YELLOW FEVER OF 1793. 175 

plague, is established by the simplicity and uniformity of 
their causes, and of their remedies. However diversified 
they may be in their symptoms, the system, in both dis- 
eases, is generally under a state of undue excitement or 
great depression, and in most cases requires the abstraction 
of stimulus in a greater or less degree, or in a sudden or 
gradual manner. There can never be any danger of the 
people injuring themselves by mistaking any other disease 
for an epidemic yellow fever or plague, for no other febrile 
disease can prevail with them. It was probably to prevent 
this mistake, that the Benevolent Father of mankind, who 
has permitted no evil to exist which does not carry its 
antidote along with it, originally imposed that law upon all 
great and mortal epidemics. 

3. The history of the yellow fever in the West- Indies 
proves the advantage of trusting patients to their own 
judgment. Dr. Lind has remarked, that a greater propor- 
tion of Sailors who had no physicians recovered from that 
fever, than of those who had the best medical assistance. 
The fresh air of the deck of a ship, a purge of salt water, 
and the free use of cold water, probably triumphed here 
over the cordial juleps of physicians. 

4. By committing the cure of this and other pestilential 
epidemics to the people, all those circumstances which 
prevented the universal success of purging and bleeding, 
in this disease, will have no operation. The fever will be 
mild in most cases, for all will prepare themselves to 
receive it, by a vegetable diet, and by moderate evacuations. 
The remedies will be used the moment the disease is felt, 
or even seen, and its violence and danger will thereby be 
obviated. There will then be no disputes among physi- 
cians, about the nature of the disease, to distract the public 
mind, for they will seldom be consulted in it. None will 
suffer from chronic debility induced by previous fatigue in 
attending the sick, nor from the want of nurses, for few 
will be so ill as to require them, and there will be no 
" foreboding'' fears of death, or despair of recovery, to 
invite an attack of the disease, or to ensure its mortality. 

The small-pox was once as fatal as the yellow fever and 
the plague. It has since yielded as universally to a vege- 
table diet and evacuations, in the hands of apothecaries, 



176 AN ACCOUNT OF THE 

the clergy, and even of the good women, as it did in the 
hands of doctors of physic. 

They have narrow conceptions, not only of the Divine 
Goodness, but of the gradual progress of human know- 
ledge, who suppose that all pestilential diseases shall not, 
like the small-pox, sooner or later cease to be the scourge 
and terror of mankind. 

For a long while, air, water, and even the light of the 
sun, were dealt out by physicians to their patients with a 
sparing hand. They possessed, for several centuries, the 
same monopoly of many artificial remedies. But a new 
order of things is rising in medicine. Air, water, and light 
are taken without the advice of a physician, and bark and 
laudanum are now prescribed every where by nurses and 
mistresses of families, with safety and advantage. Human 
reason cannot be stationary upon these subjects. The time 
must and will come, when, in addition to the above reme- 
dies, the general use of calomel, jalap, and the lencet, shall 
be considered among the most essential articles of the 
knowledge and rights of man. 

It is no more necessary that a patient should be ignorant 
of the medicine he takes, to be cured by it, than that the 
business of government should be conducted with secrecy, 
in order to insure obedience to just laws. Much less is it 
necessary that the means of life should be prescribed in a 
dead language, or dictated with the solemn pomp of a 
necromancer. The effects of imposture, in every thing, 
are like the artificial health produced by the use of ardent 
spirits. Its vigour is temporary, and is always followed 
by misery and death. 

The belief that the yellow fever and the plague are ne- 
cessarily mortal, is as much the effect of a superstitious 
torpor in the understanding, as the ancient belief that the 
epilepsy was a supernatural disease, and that it was an of- 
fence against heaven to attempt to cure it. It is partly 
from the influence of this torpor in the minds of some 
people, that the numerous cures of the yellow fever, per- 
formed by a few simple remedies, were said to be of other 
diseases. It is necessary, for the conviction of such per- 
sons, that patients should always die of that, and other dan- 
gerous disease, to prove that they have been affected by 
them. 



BILIOUS YELLOW FEVER OF 1793. 177 

The repairs whieh our world is destined to undergo will 
be incomplete, until pestilential fevers cease to be number- 
ed among the widest outlets of human life. 

There are many things which are now familiar to women 
and children, which were known a century ago only to a 
few men who lived in closets, and were distinguished by 
the name of philosophers. 

We teach a hundred things in our schools less useful, 
and many things more difficult, than the knowledge that 
would be necessary to cure a yellow fever or the plague. 

In my attempts to teach the citizens of Philadelphia, by 
my different publications, the method of curing themselves 
of yellow fever, I observed no difficulty in their appre- 
hending every thing that was addressed to them, except 
what related to the different states of the pulse. All the 
knowledge that is necessary to discover when blood-letting 
is proper, might be taught to a boy or girl of twelve years 
old in a few hours. I taught it in less time to several per- 
sons, during the prevalence of the epidemic. 

I would as soon believe that ratafia was intended by the 
Author of nature to be the only drink of man, instead of 
water, as believe that the knowledge of what relates to the 
health and lives of a whole city, or nation, should be confined 
to one, and that a small or a privileged order of men. But 
what have physicians, what have universities or medical 
societies done, after the labours and studies of many cen- 
turies, towards lessening the mortality of pestilential fevers? 
They have either copied or contradicted each other, in all 
their publications. Plagues and malignant fevers are still 
leagued with war and famine, in their ravages upon human 
life. 

To prevent the formation and mortality of this fever, it 
will be necessary, when it makes its ippearance in a city 
or country, to publish an account of those symptoms which 
I have called the precursors of the disease, and to exhort 
the people, as soon as they feel those symptoms, to have 
immediate recourse to the remedies of purging or bleeding. 
The danger of delay in using one, or both these remedies, 
should be inculcated in the strongest terms, for the disease, 
like Time, has a lock on its forehead, but is bald behind. 
The bite of a rattle-snake is seldom fatal, because the me- 
dicines which cure it are applied or taken as soon as the 

VOL. III. z 



178 AN ACCOUNT OF THE 

poison comes in contact with the blood. There is less 
clanger to be apprehended from the yellow fever than from 
the poison of the snake, provided the remedies for it are 
administered within a few hours after it is excited into 
action. 

Let persons who are subject to chronic pains, or diseases 
of any kind, be advised not to be deceived by them. Eve- 
ry pain, at such a time, is the beginning of the disease ; 
for it always acts first on debilitated parts of the body. 
From an ignorance of this law of epidemics many persons, 
by delaying their applications for help, perished with our 
fever. 

Let nature be trusted in no case whatever, to cure this 
disease ; and let no attack of it, however light, be treated 
with neglect. Death as certainly performs his work, when 
he steals on the system in the form of a mild intermittent, 
as he does, when he comes on with the symptoms of apo- 
plexy, or a black vomiting. 

Cleanliness, in houses and dress, cannot be too often in- 
culcated during the prevalence of a yellow fever. 

Let it not be supposed, that I mean that the history which 
I have given of the method of cure of this epidemic, should 
be applied, in all its parts, to the yellow fevers which may 
appear hereafter in the United States, or which exist at all 
times in the West- India islands. Season and climate vary 
this, as well as all other diseases. Bark and wine, so fatal 
in this, may be proper in a future yellow fever. But in 
the climate of the United States, I believe it will seldom 
appear with such symptoms of prostration and weakness, 
as not to require, in its first stage, evacuations of some 
kind. 

The only inquiry, when the disease makes its appearance, 
should be, from what part of the body these evacuations 
should be procured ; the order which should be pursued in 
obtaining them ; and the quantity of each of the matters to 
be discharged, which should be withdrawn at a time. 

Thus far did I venture, from my theory of the disease, 
and from the authorities of Dr. Hillary and Dr. Mosely, 
to decide in favour of evacuations in the yellow fever ; 
but Dr. Wade, and Mr. Chisholm again support me by 
their practice in the fevers of the East and West-Indies. 
They both gave strong mercurial purges, and bled in some 



BILIOUS YELLOW FEVER OF 1793. 179 

rases. Dr. Wade confirmed, by his practice, the advan- 
tage of gradually abstracting stimulus from the system. 
He never drew blood, even in the most inflammatory cases y 
until lie had first discharged the contents of the bowels. 
The doctor has further established the efficacy of a vegeta- 
ble diet and of water as a drink, as the best means of pre- 
venting disease in a hot climate. 

The manner in which the miasmata that produce the 
plague act upon the system is so much like that which has 
been described in the yellow fever, and the accounts of the 
efficacy of low diet, in preparing the body for its reception, 
and of copious bleeding, cold air and cold water, in curing 
it, are so similar, that all the directions which .j^late to 
preventing, mitigating, or curing the yellow fever may be 
applied to it. The fluids in the plague show ?. greater 
tendency to the skin, than they do in the yellow fever. 
Perhaps, upon this account, the early use of powerful 
sudorifics may be more proper in the former than in the 
latter disease. From the influence of early purging and 
bleeding in promoting sweats in the yellow fever, there can 
be little doubt but the efforts of nature to unload the system 
in the plague, through the channel of the pores, might be 
accelerated by the early use of the same remedies. One 
thing, with respect to the plague, is certain, that its cure 
depends upon the abstraction of stimulus, either by means 
of plentiful sweats, or of purulent matter from external 
sores. Perhaps the efficacy of these remedies depends 
wholly upon their elevating the system from its prostrated 
state in a gradual manner. If this be the case, those natural 
discharges might be easily and effectually imitated by small 
and repeated bleedings. , 

To correspond in quantity with the discharge from the 
skin, blood-letting in the plague, when indicated, should 
be copious. A profuse sweat, continued for twenty-four 
hours, cannot fail of wasting many pounds of the fluids of 
the body. This was the duration of the critical sweats in the 
famous plague which was known by the name of the English 
sweating sickness, and which made its appearance in the 
army of Henry VII. in Milford-Haven in Wales, and 
spread from thence through every part of the kingdom. 

The principles which lead to the prevention and cure of 
the yellow fever and the plague, apply with equal force to 



180 AN ACCOUNT OF THE 

the mitigation of the measles, and to the prevention or mi- 
tigation of the scarlatina anginosa, the dysentery, and the 
inflammatory jail fever. I have remarked elsewhere,* that 
a previous vegetable diet lessened the violence and danger 
of the measels. Dr. Sims taught me, many years ago, to 
prevent or mitigate the scarlatina anginosa, by means of 
gentle purges, after children are infected by it.f Purges 
of salts have in many instances preserved whole families 
and neighbourhoods from the dysentery, where they have 
been exposed to its remote cause. During the late Ame- 
rican war, an emetic seldom failed of preventing an attack 
of the hospital fever, when given in its forming state.J I 
have had no experience of the effects of previous evacua- 
tions in abating the violence, or preventing the mortality of 
the malignant sore throat, but I can have no doubt of their 
efficacy, from the sameness of the state of the system in 
that disease, as in other malignant fevers. The debility 
induced in it is from depression, and the supposed symp- 
toms of putrefaction are nothing but the disguised effects 
of a sudden and violent pressure of an inflammatory stimu- 
lus upon the arterial system. 

With these observations I close the history of the rise, 
progress, symptoms, and treatment of the bilious remitting 
yellow fever, which appeared in Philadelphia in the year 
1793. My principal aim has been to revive and apply to 
it, the principles and practice of Dr. Sydenham, and, how- 
ever coldly those principles and that practice my be receiv- 
ed by some physicians of the present day, I am convinced 
that experience, in all ages and in all countries, will vouch 
for their truth and utility. 

* Vol. ii. f Medical Memoirs, vol. i. t Vol. I 



BILIOUS YELLOW FEVER OF 1793. 181 



A NARRATIVE 



OF THE 

STATE OF THE BODY AND MIND OF THE AUTHOR, DURING THE 
PREVALENCE OF THE FEVER. 

NARRATIVES of escapes from great dangers of 
shipwreck, war, captivity, and famine have always formed 
an interesting part of the history of the body and mind of 
man. But there are deliverances from equal dangers which 
have hitherto passed unnoticed ; I mean from pestilential 
fevers. I shall briefly describe the state of my body and 
mind during my intercourse with the sick in the epidemic 
of 1793. The account will throw additional light upon 
the disease, and probably illustrate some of the laws of 
the animal economy : It will, moreover, serve to furnish a 
lesson to all who may be placed in similar circumstances 
to commit their lives, without fear, to the protection of that 
Being, who is able to save to the uttermost, not only from 
future, but from present evil. 

Some time before the fever made its appearance, my wife 
and children went into the state of New-Jersey, where they 
had long been in the habit of spending the summer months. 
My family, about the 25th of August, consisted of my 
mother, sister, who was on a visit to me, a black servant 
man, and a mulatto boy. I had five pupils, viz. Warner 
Washington and Edward Fisher, of Virginian ; John 
Alston, of South-Carolina, and John Redman Coxe (grand- 
son to Dr. Redman) and John Stall, both of this city. 
They all crowded around me upon the sudden increase of 
business, and with one heart devoted themselves to my 
service, and to the cause of humanity. 

The credit which the new mode of treating the disease 
acquired, in all parts of the city, produced an immense 
influx of patients to me from all quarters. My pupils were 
constantly employed ; at first in putting up purging pow- 



182 AN ACCOUNT OF THE 

ders, but, after a while, only in bleeding and visiting the 
sick. 

Between the 8th and the 15th of September I visited and 
prescribed for between a hundred and a hundred and twenty 
patients a day. Several of my pupils visited a fourth or 
fifth part of that number. For a while we refused no calls. 
In the short intervals of business, which I spent at my 
meals, my house was filled with patients, chiefly the poor, 
waiting for advice. For many weeks I seldom ate without 
prescribing for numbers as I sat at my table. To assist 
me at these hours, as well as in the night, Mr. Stall, Mr. 
Fisher, and Mr. Coxe accepted of rooms in my house, and 
became members of my family. Their labours now had 
no remission. 

Immediately after I adopted the antiphlogistic mode of 
treating the disease, I altered my manner of living. I left 
off drinking wine and malt liquors. The good effects of 
the disuse of these liquors helped to confirm me in the 
theory I had adopted of the disease. A troublesome head- 
ach, which I had occasionally felt, and which excited a 
canstant apprehension that I was taking the fever, now 
suddenly left me. I likewise, at this time, left off eating 
solid animal food, and lived wholly, but sparingly, upon 
weak broth, potatoes, raisins, coffee, and bread and butter. 

From my constant exposure to the sources of the disease, 
my body became highly impregnated with miasmata. My 
eyes were yellow, and sometimes a yellowness was percep- 
tible in my face. My pulse was preternaturally quick, and 
I had profuse sweats every night. These sweats were so 
offensive, as to oblige me to draw the bed-clothes close to 
my neck, to defend myself from their smell. They lost 
their fcetor entirely, upon my leaving off the use of broth, 
and living entirely upon milk and vegetables. But my 
nights were rendered disagreeable, not only by these sweats, 
but by the want of my usual sleep, produced in part by the 
frequent knocking at my door, and in part by anxiety 
of mind, and the stimulus of the miasmata upon my system. 
I went to bed in conformity to habit only, for it ceased to 
afford me rest or refreshment. When it was evening I 
wished for morning ; and when it was morning, the pros- 
pect of the labours of the day, at which I often shuddered, 
caused me to wish for the return of evening. The degrees 



BILIOUS YELLOW FEVER OF 1793. 183 

of my anxiety may be c ily conceived when I add, that I 
had at one time upwards of thirty heads of families under 
my care ; among these were Mr. Josiah Coates, the father 
of eight, and Mr. Benjamin Scull and Mr. John Morell, 
both fathers of ten children. They were all in imminent 
danger ; but it pleased God to make me the instrument of 
saving each of their lives. I rose at six o'clock, and 
generally found a number of persons waiting for advice in 
my shop or parlour. Hitherto the success of my practice 
gave a tone to my mind, which imparted preternatural 
vigour to my body. It was meat and drink to me to fulfil 
the duties 1 owed to my fellow-cittizens, in this time of 
great and universal distress. From a hope that I might 
escape the disease, by avoiding every thing that could 
excite it into action, I carefully avoided the heat of the sun, 
and the coldness of the evening air. I likewise avoided 
yielding to every thing that should raise or depress my 
passions. But at such a time, the events which influence 
the state of the body and mind are no more under our 
command than the winds or weather. On the evening of 
the 14th of September, after eight o'clock, I visited the son 
of Mrs. Berriman, near the Swedes' church, who had sent 
for me early in the morning. I found him very ill. He 
had been bled in the forenoon, by my advice, but his pulse 
indicated a second bleeding. It would have been difficult 
to procure a bleeder at that late hour. I therefore bled him 
myself. Heated by this act, and debilitated by the labours 
of the day, I rode home in the evening air. During 
the ensuing night I was much indisposed. I rose, notwith- 
standing at my usual hour. At eight o'clock I lost ten 
ounces of blood, and immediately afterwards got into my 
chair, and visited between forty and fifty patients before 
dinner. At the house of one of them I was forced to lie 
down a few minutes. In the course of this morning's 
labours my mind was suddenly thrown off its pivots, by 
the last look, and the pathetic cries, of a friend for help, 
who was dying under the care of a French physician. I 
came home about two o'clock, and was seized, immediately 
afterwards, with a chilly fit and a high fever. I took a 
dose of the mercurial medicine, and went to bed. In the 
evening I took a second purging powder, and lost ten 
ounces more of blood. The next morning I bathed my 



184 AN ACCOUNT OF THE 

face, hands, and feet in cold water for some time. I drank 
plentifully, during the day and night, of weak hyson tea, 
and of water, in which currant jelly had been dissolved. 
At eight o'clock I was so well as to admit persons who 
came for advice into my room, and to receive reports from 
my pupils of the state of as many of my patients as they 
were able to visit ; for, unfortunately, they were not able 
to visit them all (with their own) in due time ; in conse- 
quence of which several died. The next day I came down 
stairs, and prescribed in my parlour for not less than a 
hundred people. On the 19th of the same month, I 
resumed my labours, but in great weakness. It was with 
difficulty that I ascended a pair of stairs, by the help of a 
banister. A slow fever, attended with irregular chills, and 
a troublesome cough, hung constantly upon me. The fever 
discovered itself in the heat of my hands, which my patients 
often told me were warmer than their own. The breath 
and exhalations from the sick now began to affect me, in 
small and infected rooms, in the most sensible manner. 
On the morning of the 4th of October I suddenly sunk 
down, in a sick room, upon a bed, with a giddiness in my 
head. It continued for a few minutes, and was succeeded 
by a fever, which confined me to my house the remaining 
part of the day. 

Every moment in the intervals of my visits to the sick 
was employed in prescribing, in my own house, for the 
poor, or in sending answers to messages from my pa- 
tients ; time was now too precious to be spent in count- 
ing the number of persons who called upon me for advice. 
From circumstances I believe it was frequently 150, and 
seldom less than 50 in a day, for five or six weeks. The 
evening did not bring with it the least relaxation from my 
labours. I received letters every day from the country, 
and from distant parts of the union, containing inquiries 
into the mode of treating the disease, and after the health 
and lives of persons who had remained in the city. The 
business of every evening was to answer these letters, also 
to write to my family. These employments, by affording 
a fresh current to my thoughts, kept me from dwelling on 
the gloomy scenes of the day. After these duties were 
performed, I copied into my note book all the observations 
I had collected during the day, and which I had marked 



BILIOUS YELLOW FEVER OF 1793. 185 

frith a pencil in my pocket-book in sick rooms, or in my 
carriage. To these constant labours of body and mind 
were added distresses from a variety of causes. Having 
found myself unable to comply with the numerous appli- 
cations that were made to me, I was obliged to refuse 
many every day. My sister counted forty-seven in one 
forenoon before eleven o'clock. Many of them left my 
door with tears, but they did not feel more distress than I 
did from refusing to follow them. Sympathy, when it 
vents itself in acts of humanity, affords pleasure, and con- 
tributes to health ; but the reflux of pity, like anger, gives 
pain, and disorders the body. In riding through the streets, 
I was often forced to resist the intreaties of parents implo- 
ring a visit to their children, or of children to their parents. 
I recollect, and even yet with pain, that I tore myself at 
onetime from five persons in Moravian alley, who attempted 
to stop me, by suddenly whipping my horse, and driving 
my chair as speedily as possible beyond the reach of their 
cries. 

The solicitude of the friends of the sick for help may 
further be conceived of, when I add, that the most extra- 
vagant compensations were sometimes offered for medical 
services, and, in one instance, for only a single visit. I 
had no merit in refusing these offers, and I have introdu- 
ced an account of them only to inform such physicians as 
may hereafter be thrown into a similar situation, that I was 
favoured with an exemption from the fear of death, in 
proportion as I subdued every selfish feeling, and labour- 
ed exclusively for the benefit of others. In every instance 
in which I was forced to refuse these pathetic and earnest 
applications, my distress was heightened by the fear that 
the persons, whom I was unable to visit, would fall into 
improper hands, and perish by the use of bark, wine, and 
laudanum. 

But I had other afflictions besides the distress which 
arose from the abortive sympathy which I have described. 
On the 11th of September, my ingenious pupil, Mr. 
Washington, fell a victim to his humanity. He had taken 
lodgings in the country, where he sickened with the dis- 
Having been almost uniformly successful in curing 
others, he made light of his fever, and concealed the know- 
ledge of his danger from me, until the day before he died. 
vol. in. a a 



186 AN ACCOUNT OF THE 

On the 18th of September Mr. Stall sickened in my house. 
A delirium attended his fever from the first hour it affect- 
ed him. He refused, and even resisted force when used 
to compel him to take medicine. He died on the 23d of 
Septemher.* Scarce had I recovered from the shock of 
the death of this amiable youth* when I was called to weep 
for a third pupil, Mr. Alston, who died in my neighbour- 
hood the next day. He had worn himself down, before 
his sickness, by uncommon exertions in visiting, bleeding, 
and even sitting up with sick people. At this time Mr. 
Fisher was ill in my house. On the 26th of the month, 
at 12 o'clock, Mr. Coxe, my only assistant was seized 
with the fever, and went to his grand- father's. I followed 
him with a look, which I feared would be the last in my 
house. At two o'clock my sister, who had complained 
for several days, yielded to the disease, and retired to her 
bed. My mother followed her, much indisposed, early in 
the evening. My black servant man had been confined 
with the fever for several days, and had on that day, for 
the first time quitted his bed. My little mulatto boy, of 
eleven years old, was the only person in my family who 
was able to afford me the least assistance. At eight o'clock 
in the evening I finished the business of the day. A so- 
lemn stilness at that time pervaded the streets. In vain 
did I strive to forget my melancholy situation by answering 
letters and by putting up medicines, to be distributed next 
day among my patients. My faithful black man crept to 
my door, and at my request sat down by the fire, but he 

* This accomplished youth had made great attainments in his profes- 
sion. He possessed, with an uncommon genius for science, talents for 
music, painting, and poetry. The following copy of an unfinished letter to 
his father (who had left the city) was found among his papers after his 
death. It shows that the qualities of his heart were equal to those of his 
head. 

" Pfuladdfihia, September 15, 1793. 

" MY DEAR FATHER, 

" I take every moment I have to spare to write to you, which is not 
many ; but you must excuse me, as I am doing good to my fellow-creatures. 
At this time, every moment I spend in idleness might probably cost a life, 
the sickness increases every day, but most of those who die, die for want of 
good attendance We cure all we are called to on the first day, who are 
well attended, but s< many doctors are sick, the poor creatures are glad to 
get a doctor's servant" 



BILIOUS yellow fever'of 1793. 187 

added, by his silence and dulness, to the gloom, which 
suddenly overpowered every faculty of my mind. 

On the first day of October, at two o'clock in the after- 
noon, my sister died. I got into my carriage within an 
hour after she expired, and spent the afternoon in visiting 
patients. According as a sense of duty, or as grief has 
predominated in my mind, I have approved, and disap- 
proved, of this act, ever since. She had borne a share in 
my labours. She had been my nurse in sickness, and my 
casuist in my choice of duties. My whole heart reposed 
itself in her friendship. Upon being invited to a friend's 
house in the country, when the disease made its appear- 
ance in the city, she declined accepting the invitation, and 
gave as a reason for so doing, that I might probably re- 
quire her services in case of my taking the disease, and that, 
if she were sure of dying, she would remain with me, 
provided that, by her death, she could save my life. From 
this time I declined in health and strength. All motion 
became painful to me. My appetite began to fail. My 
night sweats continued. My short and imperfect sleep 
was disturbed by distressing or frightful dreams. The 
scenes of them were derived altogether from sick rooms 
and grave-yards. I concealed my sorrows as much as 
possible from my patients ; but when alone, the retrospect 
of what was past, and the prospect of what was before me, 
the termination of which was invisible, often filled my soul 
with the most poignant anguish. I wept frequently when 
retired from the public eye, but I did not weep over the 
lost members of my family alone. I beheld or heard every 
day of the deaths of citizens, useful in public, or amiable 
in private life. It was my misfortune to lose as patients 
the Rev. Mr. Fleming and Mr. Graesel, both exhausted 
by their labours of piety and love among the poor, before 
they sickened with the disease. I saw the last struggles of 
departing life in Mr. Powell, and deplored, in his death, an 
upright and faithful servant of the public, as well as a sin- 
cere and affectionate friend. Often did I mourn over per- 
sons who had, by the most unparalleled exertions, saved 
their friends and families from the grave, at the expense of 
their own lives. Many of these martyrs to humanity were 
in humble stations. Among the members of my profes- 
sion, with whom I have been most intimately connected, I 



188 



AN ACCOUNT OF THE 



had daily cause of grief and distress. I saw the great and 
expanded mind of Dr. Pennington, shattered by delirium, 
just before he died. He was to me dear and beloved, like 
a younger brother. He was, moreover, a Joab in the con- 
test with the disease. Philadelphia must long deplore the 
premature death of this excellent physician. Had he lived a 
few years longer, he would have filled an immense space in 
the republic of medicine.* It was my affliction to see my 
friend Dn John Morris breathe his last, and to hear the 
first effusions of the most pathetic grief from his mother, 
as she bursted from the room in which he died. But 
I had distress from the sickness, as well as the deaths of 
my brethren in physic. My worthy friends, Dn Griffitts, 
Dr. Say, and Dr. Mease, were suspended by a thread over 
the grave, nearly at the same time. Heaven, in mercy to 
me, as well as in kindness to the public and their friends, 
preserved their lives. Had they died, the measure of my 
sorrows would have been complete^ 

I have said before, that I early left off drinking wine ; 
but I used it in another way. I carried a little of it in a 
vial in my pocket, and when I felt myself fainty, after 
coming out of a sick room, or after a long ride, I kept 
about a table spoonful of it in my mouth for half a minute, 
or longer, without swallowing it. So weak and excitable 
was my system, that this small quantity of wine refreshed 
and invigorated me as much as half a pint would have done 
at any other time. The only difference was, that the vigour 
I derived from the wine in the former, was of shorter 
duration than when taken in the latter way. 

For the first two weeks after I visited patients in the 
yellow fever, I carried a rag wetted with vinegar, and 
smelled it occasionally in sick rooms : but after I saw and 
felt the signs of the universal presence of miasmata in my 
system, I laid aside this and all other precautions. I rested 
myself on the bed-side of my patients, and I drank milk 
or eat fruit in their sick rooms. Besides being saturated 
with miasmata, I had another security against being in- 
fected in sick rooms, and that was, I went into scarcely a 

* Before he finished his studies in medicine, he published a volume of 
ingenious and patriotic " Chemical and Economical Essays, designedto illus- 
trate the connection between the theory and practice of chemistry, and the 
application of that science to some of the arts and manufactures of the 
United States of America." 



BILIOUS YELLOW FEVER OF 1793. 189 

house which was more infected than my own. Many of 
the poor people, who called upon me for advice, were bled 
by my pupils in my shop, and in the yard which was between 
it and the street. From the want of a sufficient number of 
bowls to receive their blood, it was sometimes suffered to 
flow and putrefy upon the ground. From this source, 
streams of miasmata were constantly poured into my house, 
and conveyed into my body by the air, during every hour 
of the day and night. 

The deaths of my pupils and sister have often been urged 
as objections to my mode of treating the fever. Had the 
same degrees of labour and fatigue, which preceded the 
attack of the yellow fever in each of them, preceded an 
attack of a common pleurisy, I think it probable that some, 
or perhaps all of them, would have died with it. But when 
the influence of the concentrated miasmata which filled my 
house was added to that of constant fatigue upon their 
bodies, what remedies could be expected to save their 
lives ? Under the above circumstances, 1 consider the re- 
covery of the other branches of my family from the fever 
(and none of them escaped it) with emotions, such as I 
should feel had we all been revived from apparent death by 
the exertions of a humane society. 

For upwards of six weeks I did not taste animal food, 
nor fermented liquors of any kind. The quantity of aliment 
which I took, inclusive of drinks, during this time, was 
frequently not more than one or two pounds in a day. 
Yet upon this diet I possessed, for a while, uncommon 
activity of body. This influence of abstinence upon bodily 
exertion has been happily illustrated by Dr. Jackson, in 
his directions for preserving the health of soldiers in hot 
climates. He tells us, that he walked a hundred miles in 
three days, in Jamaica, during which time he breakfasted 
on tea, supped on bread and sallad, and drank nothing but 
lemonade or water. He adds further, that he waked from 
Edinburgh to London in eleven days and a half, and that 
he travelled with the most ease when he only breakfasted 
and supped, and drank nothing but water. "The fatigue 
of riding on horseback is prevented or lessened by absti- 
nence from solid food. Even the horse suffers least from 
a quick and long journey when he is fed sparingly with 
hay. These facts add weight to the arguments formerly 



190 AN ACCOUNT OF THE 

adduced, in favour of vegetable diet, in preventing or mi- 
tigating the action of the miasmata of malignant fevers 
upon the system. In both cases the abstraction of stimulus 
removes the body further from the reach of undue excite- 
ment and morbid depression. 

Food supports life as much by its stimulus, as hy 
affording nourishment to the body. Where an artificial 
stimulus, acts upon the system the natural stimulus of 
food ceases to be necessary. Under the influence of this 
principle, I increased or diminished my food with the signs 
I discovered of the increase or diminution of the seeds of 
the disease in my body. Until the 15th of September I 
drank weak coffee, but after that time I drank nothing but 
miik, or milk and water, in the intervals of my meals. I 
was so satisfied of the efficacy of this mode of living, that 
I believed life might have been preserved, and a fever 
prevented, for many days, with a much greater accumula- 
tion of miasmata in my system, by means of a total absti- 
nence from food. Poison is a relative term, and an excess 
in quantity, or a derangement in place, is necessary to its 
producing deleterious effects. The miasmata of the yellow 
fever produced sickness and death only from the excess of 
their quantity, or from their force being increased by the 
addition of those other stimuli which I have elsewhere 
called exciting causes. 

In addition to low diet, as a preventive of the disease, I 
obviated costiveness by taking occasionally a calomel pill, 
or by chewing rhubarb. 

I had read and taught, in my lectures, that fasting 
increases acnteness in the sense of touch. My low living had 
that effect, in a certain degree, upon my fingers. I had a 
quickness in my perception, of the state of the pulse in the 
yellow fever, that I had never experienced before in any 
other disease. My abstemious diet, assisted perhaps by 
the state of my feelings, had likewise an influence upon my 
mind. Ics operations were performed Math an ease and a 
celerity, which rendered my numerous and complicated 
duties much less burdensome than they would probably 
have been under other circumstances of diet, or a less 
agitated state of my passions. 

My perception of the lapse of time was new to me. It 
was uncommonly slow. The ordinary business and pur- 



BILIOUS YELLOW FEVER OF 1793. 191 

suits of men appeared to me in a light that was equally new. 
The hearse and the grave mingled themselves with every 
view I took of human affairs. Under these impressions I 
recollect being as much struck with observing a number 
of men, employed in digging the cellar of a large house, as 
I should have been, at any other time, in seeing prepara- 
tions for building a palace upon a cake of ice. I recollect, 
further, being struck with surprise, about the 1st of Octo- 
ber, in seeing a man busily employed in laying in wood 
for the approaching winter. I should as soon have thought 
of making provision for a dinner on the first day of the 
year 1800. 

In the account of my distresses, I have passed over the 
slanders which were propagated against me by some of my 
brethren. I have mentioned them only for the sake of 
declaring, in this public manner, that I most heartily for- 
give them ; and that if I discovered, at any time, an undue 
sense of the unkindness and cruelty of those slanders, it 
was not because I felt myself injured by them, but because 
I was sure they would irreparably injure my fellow-citizens, 
by lessening their confidence in the only remedies that I 
believed to be effectual in the reigning epidemic. One 
thing in my conduct towards these gentlemen may require 
justification ; and that is, my refusing to consult with them. 
A Mahometan and a Jew might as well attempt to worship 
the Supreme Being in the same temple, and through the 
medium of the same ceremonies, as two physicians of op- 
posite principles and practice attempt to confer about the 
life of the same patient. What is done in consequence of 
such negotiations (for they are not consultations) is the 
ineffectual result of neutralized opinions ; and wherever 
they take place, should be considered as the effect of a 
criminal compact between physicians, to assess the property 
of their patients, by a shameful prostitution of the dictates 
of their consciences. Besides, I early discovered that it 
was impossible for me, by any reasonings, to change the 
practice of some of my brethren. Humanity was, therefore, 
on the side of leaving them to themselves ; for the extre- 
mity of wrong in medicine, as in morals and government, 
is often a less mischief than that mixture of right and wrong 
which serves, by palliating, to perpetuate evil. 
After the loss of my health I received letters from my 



192 AN ACCOUNT OF THE 

friends in the country, pressing me, in the strongest terms, 
to leave the city. Such a step had become impracticable. 
My aged mother was too infirm to be removed, and I 
could not leave her. I was, moreover, part of a little circle 
of physicians, who had associated themselves in support of 
the new remedies. This circle would have been broken by 
my quitting the city. The weather varied the disease, and, 
in the weakest state of my body, I expected to be able, 
from the reports of my pupils, to assist my associates in 
detecting its changes, and in accommodating our remedies 
to them. Under these circumstances it pleased God to 
enable me to reply to one of the letters that urged my 
retreat from the city, that " I had resolved to stick to 
my principles, my practice, and my patients, to the last 
extremity." 

On the 9th of October, I visited a considerable number 
of patients, and, as the day was warm, I lessened the 
quantity of my clothing. Towards evening I was seized 
with a pain in the back, which obliged me to go to bed at 
eight o'clock. About twelve I awoke with a chilly fit. A 
violent fever, with acute pains in different parts of my body, 
followed it. At one o'clock I called for Mr. Fisher, who 
slept in the next room. He came instantly, with my 
affectionate black man, to my relief. I saw my danger 
painted in Mr. Fisher's countenance. He bled me plenti- 
fully, and gave me a dose of the mercurial medicine. 
This was immediately rejected. He gave me a second 
dose, which likewise acted as an emetic, and discharged a 
large quantity of bile from my stomach. The remaining 
part of the night was passed under an apprehension that my 
labours were near an end. I could hardly expect to survive 
so violent an attack of the fever, broken down, as I was, by 
labour, sickness, and grief. My wife and seven children, 
whom the great and distressing events that were passing in 
our city had jostled out of my mind for six or seven weeks, 
now resumed their former place in my affections. My wife 
had stipulated, in consenting to remain in the countr , to 
come to my assistance in case of my sickness ; but I took 
measures which, without alarming her, proved effectual in 
preventing it. My house was enveloped in foul air, and 
the probability of my death made her life doubly necessary 
to my family. In the morning the medicine operated kindly, 



BILIOUS YELLOW FEVER OF 1793, 193 

and my fever abated. In the afternoon it returned, attended 
with a great inclination to sleep. Mr. Fisher bled me 
again, which removed the sleepiness. The next day the 
fever left me, but in so weak a state, that I awoke two 
successive nights with a faintness which threatened the 
extinction of my life. It was removed each time by taking 
a little aliment. My convalescence was extremely slow. 
I returned, in a very gradual manner, to my former habits 
of diet. The smell of animal food, the first time I saw it 
at my table, forced me to leave the room. During the 
month of November, and all the winter months, I was 
harassed with a cough, and a fever somewhat of the hectic 
kind. The early warmth of the spring removed those 
complaints, and restored me, through Divine Goodness to 
my usual state of health. 

I should be deficient in gratitude, were I to conclude 
this narrative without acknowledging my obligations to my 
surviving pupils, Mr. Fisher and Mr. Coxe, for the great 
support and sympathy I derived from them in my labours 
and distresses. 

I take great pleasure likewise in acknowledging my ob- 
ligations to my former pupil, Dr. Woodhouse, who assisted 
me in the care of my patients, after I became so weak as 
not to be able to attend them with the punctuality their 
cases required. The disinterested exploits of these young 
gentlemen in the cause of humanity, and their success in 
the treatment of the disease, have endeared their names to 
hundreds, and, at the same time, afforded a prelude of their 
future eminence and usefulness in their profession. 

But wherewith shall I come before the great FATHER 
and REDEEMER of men, and what shall I render unto 
him for the issue of my life from the grave ? 

■ Here all language fails 



Come then expressive silence, muse his praise. 



VOL. III. Bb 



AN ACCOUNT 



OF THE 



BILIOUS REMITTING AND INTERMITTING 

YELLOW FEVER, 



APPEARED IN PHILADELPHIA, 



IN THE YEAR 1794. 



AX ACCOUNT, &c. 



I CONCLUDED the history of the symptoms of 
the bilious remittent yellow fever, as it appeared in Phila- 
delphia in the year 1793, by taking notice, that the disease 
which succeeded that fatal epidemic were all of a highly 
inflammatory nature. 

In that history I described the weather and diseases of 
the months of March and April, in the spring of 1794. 

The weather, during the first three weeks of the month 
of May, was dry and temperate, with now and then a cold 
day and night. The strawberries were ripe on the 15th, 
and cherries on the 22d, day of the month, in several of 
the city gardens. A shower of hail fell on the afternoon of 
the 22d, which broke the glass windows of many houses. 
A single stone of this hail was found to weigh two drachms. 
Several people collected a quantity of it, and preserved it 
till the next day in their cellars, when they used it for the 
purpose of cooling their wine. The weather, after this 
nail storm, was rainy during the remaining part of the 
month. The diseases were still inflammatory. Many per- 
sons were afflicted with a sore mouth in this month. 

The weather in June was pleasant and temperate. Several 
intermittents, and two very acute pleurisies, occurred in 
my practice during this month. The intermittents were 
uncommonly obstinate, and would not yield to the largest 
doses of the bark. 

In a son of Mr. Samuel Coates, of seven years old, the 
bark produced a sudden translation of this state of fever 
to the head, where it produced all the symptoms of the 
first stage of internal dropsy of the brain. This once 
formidable disease yielded, in this case, to three bleedings, 
and other depleting medicines. The blood drawn in every 
instance was sizy. 



198 AN ACCOUNT OF THE 

From the inflammatory complexion of the diseases of 
the spring, and of the beginning of June, I expected the 
fevers of the summer and autumn would be of a violent 
and malignant nature. I was the more disposed to enter- 
tain this opinion from observing the stagnating filth of the 
gutters of our city ; for the citizens of Philadelphia, having 
an interest in rejecting the proofs of the generation of the 
epidemic of 1793 in their city, had neglected to introduce 
the regulations which were necessary to prevent the pro- 
duction of a similar fever from domestic putrefaction. 
They had, it is true, taken pains to remove the earth and 
offal matters' which accumulated in the streets ; but these, 
from their being always dry, were inoffensive as remote 
causes of disease. Perhaps the removal of the earth did 
harm, by preventing the absorption of the miasmata which 
were constantly exhaled from the gutters. 

On the 6th of June, Dr. Physick called upon me, and 
informed me that he had a woman in the yellow fever under 
his care. The information did not surprise me, but it 
awakened suddenly in my mind the most distressing emo- 
tions. I advised him to inform the mayor of the city of 
the case, but by no means to make it more public, for I 
hoped that it might be a sporadic instance of the disease, 
and that it might not become general in the city. 

On the 12th of the month, my fears of the return of the 
) r ellow fever were revived by visiting Mr. Isaac Morris, 
whom I found very ill with a violent puking, great pain in 
his head, a red eye, and a slow tense pulse. I ordered him 
to be bled, and purged him plentifully with jalap and 
calomel. His blood had that appearance which has been 
compared by authors to the washings of raw flesh in water. 
Upon his recovery, he told me that he " suspected he had 
had the yellow fever, for that his feelings were exactly such 
as they had been in the fall of 1793, at which time he had 
an attack of that disease." 

On the 14th of June, I was sent for, in the absence of 
Dr. Mease, to visit his sister in a fever. Her mother, who 
had become intimately acquainted with the yellow fever, 
by nursing her son and mother in it, the year before, at 
once decided upon the name of her daughter's disease. 
Her symptoms were violent, but they appeared in an inter- 
mitting form. Each paroxysm of her fever was like a 



BILIOUS YELLOW FEVER OF 1793. 199 

hurricane to her whole system. It excited apprehensions 
of immediate dissolution in the minds of all her friends. 
The loss of sixty ounces of blood, by five bleedings, copi- 
ous doses of calomel and jalap, and a large blister to her 
neck, soon vanquished this malignant intermittent, without 
the aid of a single dose of bark. 

During the remaining part of the month, I was called to 
several cases of fever, which had symptoms of malignity of 
a suspicious nature. The son of Mr. Andrew Brown had 
a hemorrhage from his nose in a fever, and a case of me- 
norrhagia occurred in a woman, who was affected with but 
a slight degree of fever. 

In the course of this month, I met with several cases of 
swelled testicles, which had succeeded fevers so slight as to 
have required no medical aid. Dr. Desportes records 
similar instances of a swelling in the testicles, which ap- 
peared during the prevalence of the yellow fever in St. 
Domingo, in the year 1741.* 

In the month of July, I visited James LefFerty and Wil- 
liam Adams, both of whom had, with the usual symptoms 
of yellow fever, a yellow colour on their skin. I likewise 
attended three women, in whom I discovered the disease 
under forms in which I had often seen it in the year 1793. 
In two of them it appeared with symptoms of a violent 
colic, which yielded only to frequent bleedings. In the third, 
it appeared with symptoms of pleurisy, which was attended 
with a constant hemorrhage from" the uteris, although 
blood was drawn almost daily from her arm, for six or 
seven days. About the middle of this month many people 
complained of nausea, which in some cases produced a 
puking, without any symptoms of fever. 

During the month of August, I was called to Peter 
Denham, Mrs. Bruce, a son of Jacob Gribble, Mr. Cole, 
John Madge, Mrs. Gardiner, Miss Purdon, Mrs. Gavin, 
and Benjamin Cochran, each of Avhom had all the usual 
symptoms of the yellow fever. I found Mr. Cochran sit- 
ting on the side of his bed, with a pot in his hand, into 
which he was discharging black matter from his stomach, 
on the 6th day of the disease. He died on the next day. 
Mrs. Gavin died on the 6th day of her disease, from a want 
ol sufficient bleeding, to which she objected from the influ- 
toire des Maladies de Saint Domingiie, p 



200 AN ACCOUNT OF THE 

«nce of her friends. Besides the above persons, I visited 
Mr. George Eyre at Kensington, Mr. Thomas Fitzsim- 
mons, and Thomas M'Kean, jun. son of the chief justice 
of Pennsylvania, all of whom had the disease, but in a 
moderate degree. During this time I took no steps to alarm 
my fellow citizens with the unwelcome news of its being 
in town. But my mind was not easy in this situation, for 
I daily heard of persons who died of the disease, who might 
probably have been saved had they applied early for relief, or 
had a suspicion become general among all our physicians 
of the existence of the yellow fever in the city. The 
cholera infantum was common during this, and part of the 
preceding month. It was more obstinate and more fatal 
than in common years. 

On the 12th of this month, a letter from Baltimore an- 
nounced the existence of the yellow fever in that city. One 
of the patients whom I visited in this month, in the fever, 
Mr. Cole, brought the seeds of it in his body from that 
place. 

On the 25th of the month, two members of the commit- 
tee, lately appointed by the government of the state, for 
taking care of the health of the city, called upon me to 
know whether the yellow fever was in town. I told them 
it was, and mentioned some of the cases that had come 
under my notice ; but informed them, at the same time, 
that I had seen no case in which it had been contagious, 
and that, in every case where I had been called early, and 
where my prescriptions had been followed, the disease had 
yielded to medicine. 

On the 29th of the month I received an invitation to 
attend a meeting of the committee of health, at their office 
in Walnut- street. They interrogated me respecting the 
intelligence I had given to two of their members on the 25th. 
I repeated it to them, and mentioned the names of all the 
persons I had attended in the yellow fever since the 9th of 
June. 

Neither this, nor several subsequent communications to 
the committee of health produced the effect that was in- 
tended by them. Dr. Physick and Dr. Dewees supported 
me in my declaration, but their testimony did not protect 
me from the clamours of my fellow-citizens, nor from the 
calumnies of some of my brethren, who, while they daily 



BILIOUS YELLOW FEVER OF 1794. 201 

attended or lost patients in the yellow fever, called it by the 
less unpopular names of 

1. A common intermittent. 2. A bilious fever. 3. An 
inflammatory remitting fever. 4. A putrid fever. 5. A ner- 
vous fever. 6. A dropsy of the brain. 7. A lethargy. 8. 
Pleurisy. 9. Gout. 10. Rheumatism. 11. Colic. 12. Dysen- 
tery. And 13. Sore throat. 

It was said further, by several of the physicians of the 
city, not to be the yellow fever, because some who had 
died of it had not asighing in the beginning, and a black 
vomiting in the close of the disease. Even where the black 
vomiting and yellow skin occurred, they were said not to- 
constitute a yellow fever, for that those symptoms occurred 
in other fevers. 

Let not the reader complain of the citizens and physi- 
cians of Philadelphia alone. A similar conduct has existed 
in all cities upon the appearance of great and mortal 
epidemics. 

Nor is it any thing new for mortal diseases to receive 
mild and harmless names from physicians. The plague 
was called a spotted fever, for several months, by some of 
the physicians of London, in the year 1665. 

Notwithstanding the pains which were taken to discredit 
the report of the existence of the yellow fever in the city, 
it was finally believed by many citizens, and a number of 
families in consequence of it left the city. And in spite of 
the harmless names of intermitting and remitting fever, and 
the like, which were given to the disease, the bodies of 
persons who had died of it were conveyed to the grave, in 
several instances, upon a hearse, the way in which those 
who died of the yellow fever were buried the year before. 

From the influence of occasional showers of rain, in the 
months of September and October, the disease was fre- 
quently cheeked, so as to disappear altogether for two or 
three days in my circle of practice. It was observed, that 
while showers of rain lessened, moist or damp weather, 
without rain, increased it. 

The cold weather in October checked the fever, but did 
not banish it from the city. It appeared in November, and 
in all the succeeding winter and spring months. The wea- 
ther, during these months, being uncommonly moderate, 

VOL. III. C C 



202 AN ACCOUNT OF THE 

will account for its not being destroyed at the time in which 
the disease usually disappeared in former years. 

The causes which predisposed to this fever were the 
same as in the year 1793. Persons of full habits, strangers, 
and negroes, were most subject to it. It may seem strange 
to those persons who have read that negroes are seldom 
affected with this fever in the West- Indies, that they were 
so much affected by it in Philadelphia. There were two 
reasons for it. Their manner of living was as plentiful as 
that of white people in the West- Indies, and they generally 
resided in alleys and on the skirts of the city, where they 
were more exposed to noxious exhalation, than in its more 
open and central parts. 

The summer fruits, from being eaten before they were 
ripe, or in too large a quantity, became frequently exciting 
causes of this fever. It was awakened in one of my patients 
by a supper of peaches and milk. Cucumbers, in several 
instances, gave vigour to the miasmata which had been 
previously received into the system. Terror excited it in 
two of my patients. In one of them, a young woman, this 
terror was produced by hearing, while she sat at dinner, 
that a hearse had passed by her door with a person on it 
who had died of the yellow fever. Vexation excited it in 
a foreign master of a vessel, in consequence of a young 
woman suddenly breaking an engagement to marry him. 
The disease terminated fatally in this instance. 

It was sometimes unfortunate for patients when the 
disease was excited by an article of diet, or by any other 
cause which acted suddenly upon the system ; for it led 
both them, and in some instances their physicians, to con- 
found those exciting causes with its remote cause, and to 
view the disease without the least relation to the prevailing 
epidemic. It was from this mistake that many persons were 
said to die of intemperance, of eating ice creams, and of 
trifling colds, who certainly died of the yellow fever. The 
rum, the ice creams, and the changes in the air, in all these 
cases, acted like sparks of fire which set in motion the 
quiescent particles of tinder or gunpowder. 

I shall now proceed to describe the symptoms which 
this fever assumed during the periods which have been 
mentioned. This detail will be interesting to physicians 
who wish to see how little nature regards the nosological 



BILIOUS YELLOW FEVER OF 1794. 203 

arrangement of authors, in the formation of the symptoms 
of diseases, and how much the seasons influence epidemics. 
A physician, who had practised medicine near sixty years 
in the city of Philadelphia, declared that he had never seen 
the dysentery assume the same symptoms in any two suc- 
cessive years. The same may be said probably of nearly 
all epidemic diseases. 

In the arrangement of the symptoms of this fever, I shall 
follow the order I adopted in my Account of the Yellow 
Fever of 1793, and describe them as they appeared in the 
sanguiferous system, the liver, lungs, and brain, the ali- 
mentary canal, the secretions and excretions, the nervous 
system, the senses and appetites, upon the skin, and in the 
blood. 

Two premonitory symptoms struck me this year, which 
I did not observe in 1793. One of them was a frequent 
discharge of pale urine for a day or two before the com- 
mencement of the fever ; the other was sleep unusually 
sound, the night before the attack of the fever. The for- 
mer symptom was a precursor of the plague of Bassora, 
in the year 1773. 

I. I observed but few symptoms in the sanguiferous 
system different from what I have mentioned in the fever 
of the preceding year. The slow and intermitting pulse 
occurred in many, and a pulse nearly imperceptible, in 
three instances. It was seldom very frequent. In John 
Madge, an English farmer, who had just arrived in our city, 
it beat only 64 strokes in a minute, for several days, while 
he was so ill as to require three bleedings a day, and at no 
time of his fever did his pulse exceed 96 strokes in a 
minute. In Miss Sally Eyre, the pulse at one time was 
at 176, and at another time it was at 140 ; but this fre- 
quency of pulse was very rare. In a majority of the cases 
which came under my notice, where the danger was great, 
it seldom exceeded 80 strokes in a minute. I have been 
thus particular in describing the frequency of the pulse, 
because custom has created an expectation of that part of 
the history of fevers ; but my attention was directed chiefly 
to the different degrees of force in the pulse, as manifested 
by its tension, fulness, intermissions, and inequality of ac- 
tion. The hobbling pulse was common. In John Geraud, I 
perceived a quick stroke to succeed every two strokes of an 



204 AN ACCOUNT OF THE 

or-linary healthy pulse. The intermitting, chorded, and 
d^ pressed pulse occurred in many cases. I called it the 
year before a sulky pulse. One of my pupils, Mr. Alex- 
ander, called it more properly a locked pulse. 1 think I 
observed this state ot the pulse to occur chiefly in persons 
in whom the fever came on without a chilly lit. 

Haemorrhages occurred in all the grades of this fever, 
but less frequently in my practice this year than in the year 
before. It occurred, after a ninth bleeding, in Miss Sally 
Eyre, from the nose and bowels. It occurred from the 
nose, after a sixth bleeding, in Mrs. Gardiner, who was at 
that time in the sixth month of her pregnancy. This 
symptom, which was accompanied by a tense and quick 
pulse, induced me to repeat the bleeding a seventh time. 
The blood was very sizy. I mention this fact to establish 
the opinion that haemorrhages depend upon too much 
action in the blood-vessels, and that they are not occa- 
sioned by a dissolved state of the blood. 

There was a disposition at this time to haemorrhage in 
persons who were in apparent good health. A private, in 
a company of volunteers commanded by Major M'Pherson, 
informed me that three of his messmates were affected by 
a bleeding at the nose, for several days after they left the 
city, on their way to quell the insurrection in the western 
countries of Pennsylvania. 

II. The liver did not exhibit the usual marks of inflam- 
mation. Perhaps my mode of treating the fever prevented 
those symptoms of hepatic affection which belong to the 
yellow fever in tropical climates. The lungs were frequently 
affected ; and hence the disease was in many instances 
Ciilled a pleurisy or a catarrh. This inflammation of the 
lungs occurred in a more especial manner in the winter 
season. It was distinguished from the pleurisies of com- 
mon years by a red eye, by a vomiting of green or yellow 
bile, by black stools, and by requiring very copious blood- 
letting to cure it. 

The head was affected, in this fever, not only with coma 
and delirium, but with mania. This symptom was so 
common as to give rise to an opinion that madness was 
epidemic in our city. I saw no cause of it which was 
not connected with other symptoms of the bilious remit- 



BILIOUS YELLOW FEVER OF 1794. 205 

ting fever. The Rev. Mr. Keating, one of the ministers 
of the Roman church, informed me that he had been called 
to visit seven deranged persons in his congregation, in the 
course of one week, in the month of March. Two of 
them had made attempts upon their lives. This mania 
was probably, in each of the above cases, a symptom only 
of general fever. The dilatation of the pupil was univer- 
sal in this fever. 

Sore eyes were common during the prevalence of this 
fever. In Mrs. Learning, this affection of the eyes was 
attended with a fever of a tertian type. 

III. The alimentary canal suffered as usual in this fever. 
A vomiting was common upon the first attack of the dis- 
ease. I observed this symptom to be less common after 
the cold and rainy weather which took place about the first 
of October. 

I have in another place mentioned the influence of the 
weather upon the symptoms of this disease. In addition 
to the facts which have been formerly recorded, I shall 
add one more from Dr. Desportes. He tells us, that in 
dry weather the disease affects the head, and that the bowels 
in this case are more obstinately costive than in moist wea- 
ther. This influence of the atmosphere on the yellow 
fever will not surprise those physicians who recollect the 
remarkable passage in Hippocrates, in which he says, that 
in the violent heats of summer, fevers appeared, but with- 
out any sweat ; but if a shower, though ever so slight, 
appeared, a sweat broke out in the beginning.* I obser- 
ved further, that a vomiting rarely attended those cases 
in which there was an absence of a chilly fit in the begin- 
ning of the fever. The same observation is made by Dr. 
Desportes. f 

The matter discharged by vomiting was green or yellow 
bile in most cases. Mrs. Jones, the wife of Captain Lloyd 
Jones, and one other person, discharged black bile within 
one hour after they were attacked by the fever. I have 
taken notice, in the History of the Yellow Fever of 1793, 
that a discharge of bile in the beginning of this fever was 
always a favourable symptom. Dr. Davidson of St. Vin- 
cents, in a letter to me, dated the 22d July, 1794, makes 

* Epidemics, book XI. sect. I. 

t Les Maladies de St, Domingue, vol. I. p. 19S. 



206 AN ACCOUNT OF THE 

the same remark. It shows that the biliary ducts are open, 
and that the bile is not in that viscid and impacted state 
which is described in the dissections of Dr. Mitchel.* A 
distressing pain in the stomach, called by Dr. Cullen 
gastrodynia, attended in two instances. A burning pain in 
the stomach, and a soreness to the touch of its whole ex- 
ternal region, occurred in three or four cases. Two of 
them were in March, 1795. In Mrs. Vogles, who had 
the fever in September, 1794, the sensibility of the pit of 
the stomach was so exquisite, that she could not bear the 
weight of a sheet upon it. 

Pains in the bowels were very common. They formed 
the true bilious colic, so often mentioned by West-India 
writers. In John Madge these pains produced a hardness 
and contraction of the whole external region of the bowels. 
They were periodical in Miss Nancy Eyre, and in Mrs. 
Gardiner, and in both cases were attended with diarrhoea. 
Costiveness without pain was common, and, in some 
cases, so extremely obstinate as to resist, for several days, 
the successive and alternated use of all the usual purges of 
the shops. 

Flatulencv was less common in this fever than in the year 
1793. 

The disease appeared with symptoms of dysentery in 
several cases. 

IV. The following is an account of the state of the 
secretions and excretions in this fever. 

A puking of bile was more common this year than in 
the year 1793. It was generally of a green or yellow 
colour. I have remarked before, that two of my patients 
discharged black bile within an hour after they were affect- 
ed by the fever, and many discharged that kind of matter 
which has been compared to coffee-grounds, towards the 
close of the disease. 

The faeces were black in most cases where the symp- 
toms of the highest ^rade of the fever attended. In one 
very malignant case the most drastic purges brought away, 
by fifty evacuations, nothing but natural stools. The 
purges were continued, and finally black faeces were dis- 

* Quoted in the Account of the Yellow Fever of 1793. 



BILIOUS YELLOW FEVER OF 1794. 207 

charged, which produced immediate relief.* In one person 
the faeces were of a light colour. In this patient the yel- 
lowness in the face was of an orange colour, and continued 
so for several weeks after his recovery. 

The urine was, in most cases, high coloured. It was 
scanty in quantity in Peter Brown, and totally suppressed 
in John Madge for two days. I ascribed this defect of 
natual action in the kidneys to an engorgement in their 
blood-vessels, similar to that which takes place in the lungs 
and brain in this fever. I had for some time entertained 
this idea of a morbid affection of the kidneys, but I have 
lately been confirmed in it by the account which Dr. Chis- 
holm gives of the state of one of the kidneys, in a man 
whom he lost with the Beullam fever, at Granada. " The 
right kidney (says the doctor) was mortified, although, 
during his illness no symptom of inflammation of that 
organ was perceived."! It would seem as if the want of 
action in the kidneys, and a defect in their functions were 
not necessarily attended with pain. I recollect to have met 
with several cases in 1793, in which there was a total ab- 
sence of pain in a suppression of urine of several days 
continuance. The same observation is made by Dr. Chis- 
holm, in his account of the Beullam fever of Granada.J 
From this fact it sems probable, that pain is not the effect 
of any determinate state of animal fibres, but requires the 
concurrence of morbid or preternatural excitement to pro- 
duce it. I met with but one case of strangury in this 
fever. It terminated favourably in a few days. I have 
never seen death, in a single instance, in a fever from any 
cause, where a strangury attended, and I have seldom seen 
a fatal issue to a fever, where this symptom was acciden- 
tally produced by a blister. From this fact there would 
seem to be a connection between a morbid excitement in 
the neck of the bladder, and the safety of more vital parts 

* In the account of the effects of morbid action and inflammation, in 
tlie Outlines of Phenomena of Fever, (p. 39.) the author has mentioned the 
change of certain fluids from their natural to a bark colour. It appears in 
the secretions of the stomach and bowels, in the bile, in the urine, in car- 
les, and occasionally in die matter, which is produced by blisters. All 
these changes occur in the yellow fever, and, in common with the other 
is of fever that have been enumerated, are the result of peculiar 
actions in the vessels, derived from one cause, viz. morbid excitement. 

t Essay on the Malignant Pestilential Fever introduced into the West- 
Indies from Beullam, p. 137. 

t Page 224. 



208 AN ACCOUNT OF THE 

of the body. The idea of this connection was first sug- 
gested to mc, above thirty years ago, by the late Dr. James 
Leiper, of Maryland, who informed me that he had some- 
times cured the most dangerous cases of pleurisy, after the 
usual remedies had failed, by exciting a strangury, by 
means of the tincture of Spanish flies mixed with cam- 
phorated spirit of wine. 

The tongue was always moist in the beginning of the 
fever, but it was generally of a darker colour than last year. 
When the disease was left to itself, or treated with bark and 
wine, the tongue became of a fiery red colour, or dry and 
furrowed, as in the typhus fever. 

Sweats were more common in the remissions of this 
fever, than they were in the year 1793, but they seldom 
terminated the disease. During the course of the sweats, 
I observed a deadly coldness over the whole body to con- 
tinue in several instances, but without any danger or in- 
convenience to the patient. In two of the worst cases I 
attended, there were remissions, but no sweats until the 
day on which the fever terminated. In several of my pa- 
tients, the fever wore away without the least moisture on 
the skin. The milk, in one case, was of a greenish colour, 
such as sometimes appears in the serum of the blood. In 
another female patient who gave suck, there was no dimi- 
nution in the quantity of her milk during the whole time 
of her fever, nor did her infant suffer the least injury from 
sucking her breasts. 

I observed tears to flow from the eye of a young woman 
in this fever, at a time when her mind seemed free from 
distress of any kind. 

V. I proceed next to mention the symptoms of this 
fever in the nervous system. 

Delirium was less common than last year. I was much 
struck in observing John Madge, who had retained his 
reason while he was so ill as to require three bleedings a 
day, to become delirious as soon as he began to recover, at 
which time his pulse rose from between 60 and 70, to 96 
strokes in a minute. I saw one case of extreme danger, 
in which a hysterical laughing and weeping alternately 
attended. 

I have before mentioned the frequency of mania as a 
symptom of this disease. An obstinate wakefulness attend- 



BILIOUS YELLOW FEVER OF 1794. 209 

ed the convalescence from this fever in Peter Brown, John 
Madge, and Mr. Cole. 

Fainting was more common in this fever than in the 
fever of 1793. It ushered in the disease in one of my 
nts, and it occurred in several instances after bleeding, 
where the quantity of blood drawn was very moderate. 

Several people complained of giddiness in the first attack 
of the fever, before they were confined to their beds. 
Sighing was less common, but a hiccup was more so, than 
in the year belbre. 

John Madge had an immobility in his limbs bordering 
upon palsy. A weakness in the wrist in one case suc- 
ceeded a violent attack of the fever. 

Peter Brown complained of a most acute pain in the 
muscles of one ol his legs. It afterwards became so much 
inflamed as to require external applications to prevent the 
inflammation terminating in an abscess. Mrs. Mitchell 
complained of severe cramps in her legs. 

The sensations of pain in this fever were often expressed 
in extravagant language. The pain in the head, in a par- 
ticular manner, was compared to repeated strokes of a 
hammer upon the brain, and in two cases, in which this 
pain was accompanied by great heat, it was compared to 
the boiling of a pot. 

The more the pains were confined to the bones and back, 
the less danger was to be apprehended from the disease. 
I s„w no case of death from the yellow fever in 1793, 
where the patient complained much of pain in the back. 
It is easy to conceive how this external determination of 
morbid action should preserve more vital parts. The bili- 
ous fever of 1780 was a harmless disease, only because it 
spent its whole force chiefly upon the limbs. This was so 
generally the case, that it acquired, from the pains in the 
bones which accompanied it, the name of the " break bone 
fever." Hippocrates has remarked that pains which de- 
scend, in a fever, are more favourable than those which 
ascend.* This is probably true, but I did not observe 
any such peculiarity in the translation of pain in this fever. 
The following fact from Dr. Grainier will add weight 
to the above observations. He observed the pains in a 
malignant fever which were diffused through the whole 

* Epidemics, book ii. sect. 2. 
VOL. III. D d 



210 AN ACCOUNT OF THE 

heatf, though excruciating, were much less dangerous thai? 
when they were confined to the temples or forehead. * 

I saw two cases in which a locked jaw attended. In 
one of them it occurred only during one paroxysm of the 
fever. In both it yielded in half an hour to blood-letting. 
I met with one case in which there was universal teta- 
nus. I should have suspected this to have been the 
primary disease, had not two persons been infected in the 
same house with the yellow fever. 

The countenance sometimes put on a ghastly appearance 
in the height of a paroxysm of the fever. The face of a 
lady, admired when in health for uncommon beauty, was 
so much distorted by the commotions of her whole sys- 
tem, in a fit of the fever, as to be viewed with horror by 
all her friends. 

VI. The senses and appetites were affected in this fever 
in the following manner. 

A total blindness occurred in two persons during the 
exacerbation of the fever, and ceased during its remissions. 
A great intolerance of light occurred in several cases. It 
was most observable in John Madge during his convales- 
cence. 

A soreness in the sense of touch was so exquisite in 
Mrs. Kapper, about the crisis of her fever, that the pres- 
sure of a piece of fine muslin upon her skin gave her 
pain. 

Peter Brown, with great heat in the skin, and a quick 
pulse, had no thirst ; but a most intense degree of thirst 
was very common in this fever. It produced the same ex- 
travagance of expression that I formerly said was produ- 
ced by pain. One of my patients, Mr. Cole, said he 
" could drink up the ocean." I did not observe thirst to 
be connected with any peculiar state of the pulse. 

George Eyre and Henry Clymer had an unusual degree 
of appetite, just before the usual time of the return of a 
paroxysm of fever. 

A young man complained to me of being afflicted with 
nocturnal emissions of seed during his convalescence. This 
symptom is not a new one in malignant fevers. Hippocrates 
takes notice of it.f I met with one instance of it among 

* Historia r ebris Anomalx Batavjc Annorum 1746, 1747, 1748, cap. i. 
> Epidemics, book IV. 



BILIOUS YELLOW FEVER OF 1794. 211 

the sporadic cases of yellow fever which occurred in 1795. 
Jt sometime oceurs, according to Lomius, in the commo- 
tions of the whole system whieli take place in epilepsy. 

VII. The disease made an impression upon the lym- 
phatic system. Four of my patients had glandular swel- 
lings : two of them were in the groin ; a third was in the 
parotid ; and the fourth was in the maxillary glands. Two 
of these swellings suppurated. 

VIII. The yellowness of the skin, which sometimes 
attends this fever, was more universal, but more faint than 
in the year 1793. It was, in many cases composed of such 
a mixture of colours, as to resemble polished mahogany. 
But, in a few cases, the yellowness was of a deep orange 
colour. The former went off with the fever ; but the latter 
often continued for several weeks after the patients recover- 
< el. In some instances a red colour predominated to such 
a degree in the face, as to produce an appearance of inflam- 
mation. 

In Mrs. Volges a yellowness appeared in her eyes during 
the paroxysm of her fever, and went off in its remissions. 

In James Lefferty the yellowness affected every part of 
his body, except his hands, which were as pale as in a 
common fever. 

Peter Brown tinged his sheets of a yellow colour, by 
night sweats, many weeks after his recovery. 

There was an exudation from the soles of the feet of 
Richard Wells's maid, which tinged a towel of a yellow 
colour. 

In my Account of the Yellow Fever of 1793, I ascribed 
the yellow colour of the skin wholly to a mixture of bile 
with the blood. I believe that this is the cause of it, in 
those cases where the colour is deep, and endures for several 
weeks beyond the crisis of the fever : but where it is tran- 
sitory, and, above all, where it is local, or appears only for 
a few hours, during the paroxysm of the fever, it appears 
probable that it is connected with the mode of aggregation 
of the blood, and that it is produced wholly by some pe- 
culiar action in the blood-vessels. A similar colour takes 
place from the bite of certain animals, and from contusions 
of the skin, in neither of which cases has a suspicion been 
entertained of an absorption or mixture of bile with the 
blood. 

A troublesome itching, with an eruption of red blotches 



212 AN ACCOUNT OF THE 

on the skin, attended on the first day of the attack of the 
fever, in Mrs. Gardiner. 

A roughness of the skin, and a disposition in it to peel 
off, appeared about the crisis of the fever, in Miss Sully 
Eyre. 

That species of eruption, which I have elsewhere com- 
pared to moscheto bites, appeared in Mrs. Stllers. 

John Ray, a day labourer, to whom I was called in the 
last stage of the fever, had petechias on his breast the day 
before he died. 

That burning heat on the skin, called by the ancients 
" cAor mordens,'' and from which this fever, in some 
countries, has derived the name of causus, was more com- 
mon this year than last. It was sometimes local, and 
sometimes general. I perceived it in an exquisite degree 
in the cheeks only of Miss Sally Eyre, and over the whole 
body of John Ray. It had no connection with the rapidity 
or force of the circulation oi the blood in the latter instance, 
for it was most intense at a time when he had no pulse. 

It is remarkable that the heat of the skin has no connec- 
tion with the state of the pulse. This fact did not escape 
Dr. Chisholm. He says he found the skin to be warm 
while the pulse was at 52, and that it was sometimes disa- 
greeably cold when the puise was as quick as in ordinary 
fever.* 

IX. I have in another place rejected putrefaction from 
the blood as the cause or effect of this fever. I shall mention 
the changes which were induced in its appearances when I 
come to treat of the method of cure. 

Having described the symptoms of this fever as they 
appeared in different parts of the body, I shall now add a 
few observations upon its type or general character. 

I shall begin this part of the history of the fever by re- 
marking, that we had but one reigning disease in town 
during the autumn and winter ; that this was a bilious 
remitting, or intermitting, and sometimes a yellow fever ; 
and that all the fevers from other remote causes than putrid 
exhalation, partook more or less of the symptoms of the 
prevailing epidemic. As well might we distinguish the 
rain which falls in gentle showers in Great-Britain, from 
that which is poured in torrents from the clouds in the 

* Page 117. 



BILIOUS YELLOW FEVER OF 1794. 213 

West- Indies, by different names and qualities, as impose 
specific names and characters upon the different states of 
bilious fever. 

The forms in which this fever appeared were as follow. 

1. A tertian fever. Several persons died of the third fit 
of tertians, who were so well as to go abroad on the inter- 
mediate day of the fever. It is no new thing for malignant 
fevers to put on the form of a tertian. Hippocrates long 
ago remarked, that intermittents sometimes degenerate into 
malignant acute diseases ; and hence he advises physicians 
to be on their guard upon the 5th 7th, 9th, and even on the 
14th day of such fevers.* 

2. It appeared most frequently in the form of a remit- 
tent. The exacerbations occurred most commonly in the 
evening. In some there were exacerbations in the morning 
as well as in the evening. But I met with several patients 
who appeared to be better and worse half a dozen times in 
a day. In each of these cases, there were evident remis- 
sions and exacerbations of the fever. 

It assumed in several instances, the symptoms of a colic 
and cholera morbus. In one case the fever, after the colic 
was cured, ended in a regular intermittent. In another, the 
colic was accompanied by a haemorrhage from the nose. I 
distinguished this bilious colic from that which is excited 
by lighter causes, by its always coming on with more or 
less of a chilliness.! The symptoms of colic and cholera 
morbus occurred most frequently in June and July. 

4. It appeared in the form of a dysentery in a boy of 
William Corfield, and in a man whom my pupil, Mr. 
Alexander, visited in the neighbourhood of Harrow gate. 

5. It appeared, in one case, in the form of an apoplexy. 

6. It disguised itself in the form of madness. 

7. During the month of November, and in all the winter 
months, it was accompanied with pains in the sides and 
breast, constituting what nosologists call the " pleuritis 
biliosa." 

8. The puerperile fever was accompanied, during the 
Bummer and autumn, with more violent symptoms than 
usual. Dr. Physick informed me, that two women, to 
whom he was called soon after their delivery, died of ute- 
rine haemorrhages; and that he had with difficulty recovered 

• De Morb. Popular, lib. VII. j See Sydenham, vol. I. 212 



214 AN ACCOUNT GF THE 

two other lying-in women, who were afflicted with that 
symptom of a malignant diathesis in the blood-vessels. 

9. Even dropsies partook more or less of the inflamma- 
tory and bilious character of this fever. 

10. It blended itself with the scarlatina. The blood, in 
this disease, and in the puerperile fever, had exactly the 
same appearance that it had in the yellow fever. A yellow- 
ness in the eyes accompanied the latter disease in one case 
that came under my notice. 

A slight shivering ushered in the fever in several instan- 
ces. But the worst cases I saw came on without a chilly 
fit, or the least sense of coldness in any part of the body. 

Such was the predominance of the intermitting, remitting, 
and bilious fever, that the measles, the small-pox, and even 
the gout itself, partook more or less of its character. There 
were several instances in which the measles, and one in 
which the gout appeared with quotidian exacerbations; and 
two in which madness appeared regularly in the form of a 
tertian. 

I mentioned formerly that this fever sometimes went off 
with a sweat, when it appeared in a tertian form. This was 
always the case with the second grade of the fever, but 
never with the first degree of it, before the third or fourth 
paroxysm ; nor did a sweat occur on the fifth or seventh 
day, except after the use of depleting remedies. This pe- 
culiarity in the fever of this year was so fixed, that it gave 
occasion for my comparing it, in my intercourse with my 
patients, to a lion on the first seven days, and to a lamb 
during the remaining part of its duration. 

The fever differed from the fever of the preceding year 
in an important particular. I saw or heard of no case which 
terminated in death on the first or third day. In every case, 
the fever came on fraught with paroxysms. The moderate 
degrees of it were of so chronic a nature as to continue for 
several weeks, when left to themselves. I wish this pecu- 
liarity in the epidemic which I am now describing to be 
remembered ; for it will serve hereafter to explain the reason 
why a treatment apparently different should be alike suc- 
cessful, in different seasons and in different countries. 

The crisis of the fever occurred on uneven days more 
frequently than in the fever of the year 1793. 



BILIOUS YELLOW FEVER OF 1794. 215 

I remarked formerly* that remissions were more com- 
mon in the yellow fever than in the common bilious fever. 
The same observation applies to critical days. They were 
observable in almost every case in which the disease was 
not strangled in its birth. Dr. Chisholm describes the same 
peculiarity in the Buellam fever. " I have not met with any 
disease (says the doctor) in which the periods were more 
accurately ascertained, "f 

In addition to the instances formerly enumerated,! of the 
predominance of powerful epidemics over other diseases, I 
shall add two more, which I have lately met with in the 
course of my reading. 

Dr. Chisholm, in describing the pestilential fever intro- 
duced into the West-Indies from Buellam, has the follow- 
ing remarks. " Most other diseases degenerated into, or 
partook very much of this. Dysenteries suddenly stopped, 
and were immediately succeeded by the symptoms of the 
pestilential fever. Catarrhal complaints, simple at first, 
soon changed their nature ; convalescents from other dis- 
eases were very subject to this, but it generally proved 
mild. Those labouring at the same time under chronic 
complaints, particularly rheumatism and hepatitis, were 
very subject to it. The puerperile fever became malignant, 
and of course fatal ; and even pregnant negro women, who 
otherwise might have had it in the usual mild degree pecu- 
liar to that description of people, were reduced to a very 
dangerous situation by it. In short, every disease in which 
the patient was liable to infection, sooner or later assumed 
the appearance, and acquired the danger of the pestilential 
iever."§ l 

Dr. Desportes ascribes the same universal empire to the 
yellow fever which prevailed in St. Domingo, in the sum- 
mer of 1733. " The fever of Siam (says the doctor) con- 
veyed an infinite number of men to the grave, in a short 
time ; but I saw but one woman who was attacked by it." 
11 The violence of this disease was such, that it subjected 
all other diseases, and reigned alone. This is the character 
Of all contagious and pestilential diseases. Sydenham, and 
lx fore him Diemerbroek, have remarked this of the plague. "|j 

* Account of the Yellow Fever of 1793. f Page 141. 

count of the Yellow Fever in 1793. § Page 129, 130. 

41. See also p. Ill, 230, 231. vol. I. 



216 AN ACCOUNT OF THE 

\ 

In Baltimore the small-pox in the natural way was at- 
tended with unusual malignity and mortality, occasioned 
by its being combined with the reigning yellow fever. 

It has been urged as an objection to the influence of 
powerful epidemics chasing away, or bleeding with fevers 
of inferior force, that the measles sometimes supplant the 
small-pox, and mild intermittents take the place of fevers 
of great malignity. This fact did not escape the micros- 
copic eye of Dr. Sydenham, nor is it difficult to exphiin 
the cause of it. It is well known that epidemics, like 
simple fevers, are most violent at their first appearance, and 
that they gradually lose their force as they disappear ; now 
it is in their evanescent and feeble state, that they are jostled 
out of their order of danger or force, and yield to the 
youthful strength of epidemics, more feeble under equal 
circumstances of age than themselves. But admitting, 
powerful epidemics do not lose any part of their force by 
their duration, the system from habit, loses its susceptibi- 
lity to their action to such a degree, as to yield to the new 
impressions of such as are of a more feebie nature. From 
this change in the character of violent epidemics, they have 
been said to invade with the fury of a savage, and to retire 
with the gentleness of a civilized foe. 

It is agreeable to discover from these facts and observa- 
tions, that epidemic diseases, however irregular they appear 
at a first sight, are all subject to certain laws, and partake 
of the order and harmony of the universe. 

The action of the miasmata upon the body, when from 
the absence of an exciting cause, they did not produce 
fever, was the same as I have elsewhere described. The 
sensations which I experienced, in entering a small room 
where a person was confined with this fever, were so exactly 
the same with those I felt the year before, that I think I 
could have distinguished the presence of the disease with- 
out the assistance of my eyes, or without asking a single 
question. After sitting a few minutes in a sick room, I 
became languid and fainty. Weakness and chilliness fol- 
lowed every vi^it I paid to a gentleman at Mr. Oeller's 
hotel, which continued for half an hour. A burning in my 
stomach, great heaviness, and a slight inflammation in my 
eyes, with a constant discharge of a watery humour from 
them for two days, succeeded the first visit I paid to Mrs. 



BILIOUS YELLOW FEVER OF 1794. 217 

Sellers. These symptoms came on in less than ten minutes 
after I left her room. They were probably excited thus 
early, and in the degree which I have mentioned, by my 
having received her breath in my face by inspecting her 
tonsils, which were ulcerated on the first attack of the fever. 
I formerly supposed these changes in my body were proofs 
of the contagious nature of the yellow fever, but I shall 
hereafter explain them upon other principles. 

I recollect having more than once perceived a smell which 
had been familiar to me during the prevalence of the yellow 
fever in 1793. It resembled the smell of liver of sulphur, 
I suspected for a while that it arose from the exhalations 
of the gutters of the city. But an accident taught me that 
it was produced by the perspiration of my body. Upon 
rubbing my hands, this odour was increased so as to be- 
come not only more perceptible to myself, but in the most 
sensible degree to my pupil, Mr. Otto. From this tact, I 
was convinced that I was strongly impregnated with mias- 
mata, and I was led by it to live chiefly upon vegetables, 
to drink no wine, and to avoid, with double care, all the 
usual exciting causes of fever. 

There was another mark by which I distinguished the 
presence of the seeds of this fever in my system, and that 
was, wine imparted a burning sensation to my tongue and 
throat, such as is felt after it has been taken in excess, or 
in the beginning of a fever. Several persons, who were 
exposed to the miasmata, informed me that wine, even in 
the smallest quantity, affected them exactly in the same 
manner. 

I attended four persons in this fever who had had it the 
year before. 

It remains now that I mention the origin of this fever. 
This was very evident. It was produced by the exhala- 
tions from the gutters, and the stagnating ponds of water 
in the neighbourhood of the city. Where there was most 
exhalation, there were most persons affected by the fever. 
Hence the poor people, who generally live in the neighbour- 
hood of the ponds in the suburbs, were the greatest suf- 
ferers bv it. Four persons had the fever in Spruce, between 
fourth and fifth-streets, in which part of the city the smell 
from the gutters was extremely offensive every evening. 
In Water-streets, between Market and Walnut- streets 

VOL. III. EC 



218 AN ACCOUNT OF THE 

many persons had the fever : now the filth of that confined 
part of the city is well known to every citizen. 

I have before remarked, that one reason why most of 
our physicians refused to admit the presence of the yellow 
fever in the city, was because they could not fix upon a 
vestige of its being imported. On the 25th of August, 
the brig Commerce arrived in the river, from St. Mark, 
commanded by Captain Shirtliff. After lying five days at 
the fort, she came up to the city. A boy, who had been 
shut out from his lodgings, went, in a state of intoxication, 
and slept on her deck, exposed to the night air, in conse- 
quence of which the fever was excited in him. This event 
gave occasion, for a few days, to a report that the disease 
was inported, and several of the physicians, who had ne- 
glected to attend to all the circumstances that have been 
stated, admitted the yellow fever to be in town. An in- 
vestigation of this supposed origin of the disease soon dis- 
covered that it had no foundation. At the time of the 
arrival of this ship, I had attended nearly thirty persons 
with the fever, and upwards of a hundred had had it, under 
the care of other physicians. 

The generation of the yellow fever in our city was ren- 
dered more certain by the prevalence of bilious diseases in 
every part of the United States, and, in several of them, 
in the grade of yellow fever. It was common in Charles- 
ton, in South- Carolina, where it carried off many people, 
and where no suspicion was entertained of its being of 
West-India origin. It prevailed with great mortality at 
that part of the city of Baltimore, which is known by the 
name of Fell's Point, where, Dr. Drysdale assures me, it 
was evidently generated. A few sporadic cases of it oc- 
curred in New- York, which were produced by the morbid 
exhalation from the docks of that city. Sporadic cases of 
it occurred likewise in most of the states, in which the 
proofs of its being generated were obvious to common ob- 
servation ; and where the symptoms of depressed pulse, 
yellowness of the skin, and black discharges from the 
bowels and stomach (symptoms which mark the highest 
grade of bilious remitting fever) did not occur, the fevers 
in all their form of tertian, quotidian, colic, and dysentery, 
were uncommonly obstinate or fatal in every state in the 
union. In New-Haven only, where the yellow fever was 



BILIOUS YELLOW FEVER OF 1794. 219 

epidemic, it was said to have been imported from Marti- 
nique, but this opinion was proved to be erroneous by un- 
answerable documents, published afterwards in the Medical 
Repository, by Dr. Elisha Smith, of New- York. 

The year 1795 furnished several melancholy proofs of 
the American origin of the yellow fever. All the physi- 
cians and citizens of New- York and Norfolk agree in its 
having been generated in their respective cities that year. 
It prevailed with great mortality at the same time in the 
neighbourhood of the lakes, and on the Maters of the 
Genesee river, in the state of New- York. From its situa- 
tion it obtained the name of the lake and Genesee fever. 
It was so general, in some parts of that new country, as 
to affect horses. 

Thus have I endeavoured to fix the predisposing and 
remote causes of the yellow fever in our country. The 
remote cause is sometimes so powerful as to become an 
exciting cause of the disease, but in general both the pre- 
disposing and remote causes are harmless in the system, 
until they be roused into action by some exciting cause. 

I shall conclude this account of the symptoms and ori- 
gin of the yellow fever, by relating two facts, which serious 
and contemplating minds will apply to a more interesting 
subject. 

1. Notwithstanding the numerous proofs of the preva- 
lence of the yellow fever in Philadelphia in the year 1794, 
which have been mentioned, there are many thousands of 
our citizens, and a majority of our physicians, who do not 
believe that a case of it existed at that time in the city ; 
nor is a single record of it to be met with in any of the 
newspapers, or other public documents of that fever. Let 
us learn from this fact, that the denial of events, or a gene- 
ral silence upon the subject of them, is no refutation of 
their truth, where they opposed the pride or interests of the 
learned, or the great. 

2. Notwithstanding the general denial of the existence 
of the yellow fever in Philadelphia, and the silence observ- 
ed by our newspapers relative to it in 1794, there was 
scarcely a citizen or physician who, three years afterwards, 
did not admit of its having prevailed in that year. We 
learn from this fact another important truth, that departed 
vice and error have no friends nor advocates. 



220 AN ACCOUNT OF THE 



OF THE METHOD OF CURE. 

THE remedies employed for the cure of this fever 
were the same that I employed the year before. I shall only 
relate such effects of them as tend more fully to establish 
the practice adopted in the year 1793, and such as escaped 
my notice in my former remarks upon those remedies. My 
method of cure consisted, 

I. In the abstraction of the stimulus of blood and heat 
from the whole body, and of bile and other acrid humours 
from the bowels, by means of the following remedies : 

1. Bleeding. 

2. Purging. 

3. Cool air and cold drinks. 

4. Cold water applied to the external parts of the body 
and to the bowels by means of clysters. 

II. In creating a diversion of congestion, inflammation, 
and serous effusion, from the brain and viscera to the.mouth 
by means of a salivation, and to the external parts of the 
body, by means of blisters. 

III. In restoring the strength of the system, by tonic 
remedies. 

I proceed to make a few remarks upon the remedies set 
down under each of the above heads. 

I. I have taken notice that this fever differed from the 
fever of 1793, in coming forward in July and August with 
a number of paroxysms, which refused to yield to purging 
alone. I therefore began the cure of every case I was called 
to by bleeding. 

I shall mention the effects of this remedy, and the cir- 
cumstances, manner, and degrees in which I used it occa- 
sionilly, in this fever, in my defence of Blood-letting. 
Under the present head I shall only furnish the reader with 
a table of the quantity of blood drawn from a number of 
my patients in the course of the disease. From several of 
them the quantity set down was taken in three, four, and 
five da s. I shall afterwards describe the appearances of 
the blood. 



BILIOUS YELLOW FEVER OF 1794. 



221 



Month. 


Patients. 


Quantity 


Number of 






ounces. 


times bled. 


August. 


Peter Denham 


50 


5 




Mrs. Bruce 


70 


8 




Andrew Gribble, 








aged 15 years. 


50 


5 




John Madge 


150 


12 




Peter Brown 


80 


8 


September. 


Mrs. Gardiner 


80 


7 




Miss Sally Eyre 


80 


9 




Mrs. Gass 


50 


3 




Richard Wells's 








maid 


100 


10 




Mr. Norval 


100 


9 




Mr. Harrison 


90 


9 




Henry Clymer 


80 


8 


October. 


Mrs. Mitchell 


120 


13 




Mrs. Lenox 


80 


7 




Mrs. Kapper 


140 


11 




Rev. Dr. Magaw's 








maid 


100 


10 




Miss Hood 


100 


10 




Mrs. Vogles 


70 


5 


1795 


Guy Stone 


100 


9 


January. 


Bcnj. Hancock 


100 


10 




Mr. Benton 


■430 


13 




Mrs. Fries 


150 


15 




Mrs. Garrigues 


80 


7.1 



Three of the women, whose names I have mentioned, 
were in the advanced stage of pregnancy, viz. Mrs. Gardi- 
ner, Mrs. Gass, and Mrs. Garrigues. They have; all since 
borne healthy children. I have omitted the names, of above 
one hundred persons who had the fever, from whom I drew 
thirty or forty ounces of blood, by two or three bleedings. 
I did not cure a single person without at least one bleeding. 

It is only by contemplating the extent in which it is ne- 
cessary to use this remedy, in order to overcome a yellow 
fever, that we can acquire just ideas of its force. .Hitherto 
this force has been estimated by no other measure ;than the 



222 AN ACCOUNT OF THE 

grave, and this, we know, puts the strength of diseases 
upon a level. 

The blood drawn in this fever exhibited the following 
appearances. 

1. It was dissolved in a few instances. 

2. The crassamentum of the blood was so partially dis- 
solved in the serum, as to produce an appearance in the 
serum resembling the washings of flesh in water. 

3. The serum was so lightly tinged of a red colour as to 
be perfectly transparent. 

4. The serum was, in many cases, of a deep yellow 
colour. 

5. There was, in every case in which the blood was not 
dissolved, or in which the second appearance that has been 
mentioned did not take place, a beautiful scarlet-coloured 
sediment in the bottom of the bowl, forming lines, or a 
large circle. It seemed to be a tendency of the blood to 
dissolution. This state of the blood occurred in almost all 
the diseases of the two last years, and in some in which 
there was not the least suspicion of the miasmata of the 
yellow fever. 

6. The crassamentum generally floated in the serum, but 
it sometimes sunk to the bottom of the bowl. In the latter 
case the serum had a muddy appearance. 

7. I saw but one case in which there was not a separation 
of the crassamentum and serum of the blood. Its colour 
in this case was of a deep scarlet. In the year 1793 this 
appearance was very common. 

8. I saw one case in which the blood drawn, amounting 
to 14 ounces, separated partially, and was of a deep black 
colour. This blood was taken from Mr. Norval, a citizen 
of North-Carolina. 

9. There was, in several instances, a transparent jelly- 
like pelicle which covered the crassamentum of the blood, 
and which was easily separated from it without altering its 
texture. It appeared to have no connection with the blood. 

10. The blood, towards the crisis of the fever in many 
people, exhibited the usual forms of inflammatory crust. It 
was cupped in many instance^. 

IT. After the loss of 70 or 80 ounces of blood there was 
an evident disproportion of the quantity of crassamentum 



BILIOUS YELLOW FEVER OF 1794. 223 

to the serum. It was sometimes less, by one half, than in 
the first bleedings. 

Under this head it will be proper to mention that the 
blood, when it happened to flow along the external part of 
the arm in falling into the bowl, was so warm as to excite 
an unpleasant sensation of heat in several patients. 

To the appearances exhibited by the blood to the eye, I 
shall add a fact communicated to me by a German bleeder, 
who followed his business in the city during the prevalence 
of the fever in 1793. He informed me that he could dis- 
tinguish a yellow fever from all other states of fever, by a 
peculiar smell which the blood emitted while it was flowing 
from a vein. From the certainty of his decision in one case 
which came under my notice, before a suspicion had taken 
place of the fever being in the city, I am disposed to believe 
that there is a foundation for his remark. 

II. I have but little to add to the remarks I made upon 
the use of purging in the year 1793. I gave jalap, calomel, 
and gamboge until I obtained large and dark-coloured 
stools ; after which I kept the bowels gently open every day 
with castor oil, cremor tartar, or glauber's salts. I gave 
.calomel in much larger quantities than I did the year before. 
John Madge took nearly 150 grains of it in six days. I 
should have thought this a large quantity, had I not since 
read that Dr. Chisholm gave 400 grains of it to one patient 
in the course of his fever, and 50 grains to another at a 
single dose, three times a day. I found strong mercurial 
purges to be extremely useful in the winter months, when 
the fever put on symptoms of pleurisy. I am not singular 
in ascribing much to the efficacy of purges in the bilious 
pleurisy. Dr. Desportes tells us that he found the pleurisy 
of St. Domingo, which was of a bilious kind, to end hap- 
pily in proportion as the bowels were kept constantly open.* 
Nor am I singular in keeping my eye upon the original 
type of a disease, which only changes its symptoms with 
the weather or the season, and in treating it with the same 
remedies. Dr. Sydenham bled as freely in the diarrhoea of 
1668, as he had done in the inflammatory fever of the pre- 
ceding year.f How long the pleurisies of winter, in the city 
of Philadelphia, may continue to retain the bilious symp- 
toms of autumn, which they have assumed for three years 

* Page 140. t Wallis's edition, p. 211. vol. i. 



224 AN ACCOUNT OF THE 

past, I know not ; but the late Dr. Faysseaux, of South- 
Carolina, informed me, that for many years he had not seen 
a pleurisy in Charleston with the common inflammatory 
symptoms which characterised that disease when he was a 
student of medicine. They all now put on bilious symp- 
toms, and require strong purges to cure them. The pleu- 
risies which the late Dr. Chalmers supposes he cured by 
purging were probably nothing but bilious fevers, in which 
the cool weather had excited some pleuritic symptoms. 

3. I have nothing to add to the remarks I have elsewhere 
published upon the efficacy of cool air and cold drinks in 
this fever. They were both equally pleasant and useful, 
and contributed, with cleanliness, very much to the success 
of my practice. 

4. Cold water, applied to the external parts of the body, 
and injected into the bowels by way of clyster, did great 
service in many cases. John Madge found great relief 
from clothes dipped in cold water, and applied to the 
lower part of his belly. They eased a pain in his bowels, 
and procured a discharge of urine. A throbbing and 
most distressing pain in the head was relieved by the same 
remedy, in Mrs. Vogles and Mrs. Lenox. The cloths 
were applied for three successive days and nights to Mrs. 
Lenox's head, during an inflammation of her brain, which 
succeeded her fever, and were changed, during the greater 
part of the time, every ten or fifteen minutes. In 1795, 1 
increased the coldness of pump water, when used in this 
way, by dissolving ice in it, and in some cases I applied 
powdered ice in a bladder to the head, with great advan- 
tage. 

The following facts will show the good effects of cold 
water in this, as well as other fevers of too much action. 

In the afternoon of one of those days in which my sys- 
tem was impregnated with the miasmata of the yellow 
fever, I felt so much indisposed that I deliberated whether 
I should go to bed or visit a patient about a mile in the 
country. The afternoon was cool and rainy. I recollected, 
at this time, a case related by Dr. Daignan, a French phy- 
sician, of a man who was cured of the plague, by being 
forced to lie all night in an open field, in a shower of rain. 
I got into my chair, and exposed myself to the rain. It 
was extremely grateful to my feelings. In two hours I 



BILIOUS YELLOW FEVER OF 1794. 225 

returned, when, to my great satisfaction, I found all my 
feverish symptoms had left me, nor had I the least return 
of them afterwards. 

Dr. Caldwell, who acted as a surgeon of a regiment, in 
the expedition against the insurgents in the western coun- 
tries of Pennsylvania, furnished me, in a letter dated from 
Bedford, October 20th, 1794, with an account of his hav- 
ing been cured of a fever, by a more copious use of the 
same remedy. " I was (says the doctor) to use a vulgar 
expression, wet to the skin, and had no opportunity of 
shifting my clothes for several hours. In consequence 
of this thorough bathing, and my subsequent exposure to 
a cool air, I was relieved from every symptom of indispo- 
sition in a few hours, and have enjoyed more than my usual 
stock of health ever since." 

The efficacy of cold water, in preventing and curing in- 
flammation, may be conceived from its effects when used 
with mud or clay, for obviating the pain and inflammation 
which arise from the sting of venomous insects. The 
same remedy, applied for half an hour, has lately, it is said, 
been equally effectual in preventing the deleterious effects 
of the bite of a rattle- snake. 

II. The good effects I had observed from the salivation 
in the yellow fever of 1793, induced me to excite it as 
early as possible, in all those cases which did not yield im- 
mediately to bleeding and purging. I was delighted with 
its effects in every case in which it took place. These 
effects were as follow : 

1. It immediately attracted and concentrated in the mouth 
all the scattered pains of every part of the body. 

2. It checked a nausea and vomiting. 

3. It gradually, when it was copious, reduced the pulse, 
and thereby prevented the necessity of further bleeding or 
purging. 

I wish it were possible to render the use of this remedy 
universal in the treatment of malignant fevers. Dr. Chis- 
holm, in his account of the Bcullam fever, has done much 
to establish its safety and efficacy. It is a rare occurrence 
for a patient that has been sufficiently bled and purged, to 
die after a salivation takes place. The artificial disease ex- 
cited by the mercury suspends or destroys disease in every 
part of the body. The occasional inconveniences which 

VOL. III. F f 



226 AN ACCOUNT Of THE 

attend it are not to be named with its certain and universal 
advantages. During the whole of the season in which the 
yellow fever prevailed, I saw but two instances in which it 
probably loosened or destroyed the teeth. I am not cer- 
tain that the mercury was the cause of the injury or loss 
of those teeth ; for who has not seen malignant fevers ter- 
minate in ulcers, which have ended in the erosions of bony 
parts of the body ? 

It has been justly remarked, that there can be but one 
action at a time in the blood-vessels. This was frequently 
illustrated by the manner in which mercury acted upon the 
system in this fever. It seldom salivated until the fever 
intermitted or declined. I saw several cases in which the 
salivation came on during the intermission, and went off 
during its exacerbation ; and many, in which there was no 
salivation until the morbid action had ceased altogether in 
the blood-vessels, by the solution of the fever. It is be- 
cause the action of the vessels, in epilepsy and pulmonary 
consumption, surpasses the stimulus of the mercury, that 
it is so difficult to excite a salivation in both those dis- 
eases. 

Let not the advocates for the healing powers of nature 
complain of a salivation as an unnatural remedy in fevers. 
Dr. Sydenham speaks in high terms of it, in the fever of 
1670, 1671, and 1672, in which cases it occurred sponta- 
neously, and says that it cured it when it was so malignant 
as to be accompanied by purple spots on the body.* 

Blisters, when applied at a proper time, did great service 
in this fever. This time was, when the fever was so much 
weakened by evacuations, that the artificial pain excited by 
the stimulus of the blisters destroyed, and, like a conduc- 
tor, conveyed oft' all the natural pain of the body. It is 
from ignorance, or inattention to the proper stage of fevers 
in which blisters have been applied, that there have been 
so many disputes among physicians respecting their effica- 
cy. When applied in a state of great arterial action, they 
do harm ; when applied after that action has nearly ceased, 
they do little or no service. I have called the period in 
which blisters are useful the blistering point. In bilious 
fevers this pointis generally circumscribed within eight and 
forty hours. 

The effects of blisters were as follow : 

* Vol. it. p. 212. 



BILIOUS YELLOW FEVER OF 1794. 227 

1. They concentrated, like a salivation, all the scattered 
pains of the body, and thereby, 

2. Reduced the pulse in force and frequency. 

3. They instantly checked a sickness at the stomach 
and vomiting. 

4. The}- often induced a gentle moisture upon the skin. 
I found it of little consequence to what part of the body 

the blisters were applied ; for I observed a pain in the head, 
and even delirium, to be as speedily and certainly cured 
by blisters upon the wrists, as they were by a large blister 
to the neck. 

III. After the reduction of the morbid action of the 
blood-vessels, by means of the remedies which have been 
mentioned, I seldom made use of any other tonic than a 
nourishing and gently stimulating diet. This consisted of 
summer fruits, bread and milk, chicken broth, the white 
meats, eggs, oysters, and malt liquors, more especially 
porter. I made many attempts to cure this fever when it 
appeared in the form of a simple intermittent, without 
malignant symptoms, by means of bark, but always, except 
in two instances, without success ; and in them it did not 
take effect until after bleeding. In several cases it evidently 
did harm. I should have suspected my judgment in these 
observations respecting this medicine, had I not been assur- 
ed by Dr. Griffits, Dr. Physick, and Dr. Woodhouse, that 
it was equally ineffectual in their practice, in nearly all the 
cases in which they gave it, and even where blood-letting 
had been premised. Dr. Woodhouse saw a case in which 
nearly a pound of bark had been taken without effect ; and 
another in which a fatal dropsy succeeded its use. Dr. 
Griffits excepted, from his testimony against the bark, the 
cases of seven persons from the country, who brought the 
seeds of the intermitting fever with them to the city. In 
them the bark succeeded without previous bleeding. The 
facility with which these seven cases of intermitting fever 
were cured by the bark, clearly proves that levers of the 
same season differ very much, according to the nature of 
the exhalation which excites Uiem. The intermittents in 
these strangers were excited by miasmata of less force 
than that which was generated in our city, in which, from 
the greater heat of the atmosphere, and the more heteroge- 
neous nature of the putrid matters which stagnate in our 



228 AN ACCOUNT OF THE 

ponds and gutters, the exhalation probably possesses a more 
active and stimulating quality. Thus the mild remittents 
in June, and in the beginning of July, which were produ- 
ced by the usual filth of the streets of Philadelphia, in the 
year 1793, differed very much from the malignant remitting 
yellow fever which was produced by the stench of the putrid 
coffee a few weeks afterwards. 

Sir John Pringle long ago taught the inefficacy of bark 
in certain bilious fevers. But Dr. Chisholm has done great 
service to medicine by recording its ill effects in the Beul- 
lam fever. " Head-ach (says the doctor,) a heavy dull eye, 
with a considerable protrusion from its orbits, low spirits, 
thirst, and a total want of appetite, were the general conse- 
quences of the treatment with bark without the previous 
antiphlogistic." 

I have mentioned a case of internal dropsy of the brain 
having been produced by the improper use of the bark, in a 
son of Mr. Coates. I have no doubt but this disease, as 
also palsy and consumption, obstructions of the liver and 
bowels, and dropsies of the belly and limbs, are often indu- 
ced by the use of the bark, during an inflammatory state of 
the blood-vessels. It is to be lamented that the association 
of certain diseases and remedies, in the minds of physicians, 
becomes so fixed, as to refuse to yield to the influence of 
reason. Thus pain and opium, dropsy and foxglove, low 
spirits and assafcetida, and above all, an intermitting fever 
and bark, are all connected together, in common practice, 
as mechanically as the candle and the snuffers are in the 
mind of an old and steady house servant. To abolish the 
mischief of these mechanical associations in medicine, it 
will be necessary for physicians to prescribe only for the 
different states of the system. 

Findinar the bark to be so universallv ineffectual or hurtful, 
I substituted columbo root, the carribean bark, and several 
other bitters, in its place, but without success. They did 
less harm than the Jesuit's bark, but they did not check the 
return of a single paroxysm of fever. 

I know that bark was given in this fever in some instan- 
ces in which the patients recovered ; but they were subject, 
during the winter, and in the following spring, to frequent 
relapses, and in some instances, to affections of the brain 
and lungs. In the highest grade of the fever it certainly 



BILIOUS YELLOW FEVER OF 1794. 229 

accelerated a supposed putrefaction of the blood, and pre- 
cipitated death. The practice of physicians who create this 
gangrenous state of fever by means of the bark, resembles 
the conduct of a horse, who attempts by pawing to remove 
his shadow in a stream of water, and thereby renders it so 
turbid that he is unable to drink it. 

Should the immediate success of tonic and depleting 
medicines in destroying the fever be equal, the effects of the 
former upon the constitution cannot fail of being less safe 
tlian the latter remedies. They cure by overstraining the 
powers of life. There is the same difference, therefore, 
between the two modes of practice, that there is between 
gently lifting the latch of a door, and breaking it open, in 
order to go into a house. 

I Tine was hurtful in every case of yellow fever in which 
it was given, while there were any remains of inflammatory 
action in the system. I recollect that a few spoonsful of it, 
which Mr. Harrison of Virginia took in the depressed state 
of his pulse, excited a sensation in his stomach which he 
compared to a fire. Even wine- whey, in the excitable state 
of the system induced by this fever, was sometimes hurtful. 
In a patient of Dr. Physick, who was on the recovery, it 
produced a relapse that had nearly proved fatal, in the year 
1795. Dr. Desperrieres ascribes the death of a patient to 
a small quantity of wine given to him by a black nurse.* 
These facts are important, inasmuch as wine is a medicine 
which patients are most apt to use in all cases, without the 
advice of a physician. 

I observed opium to be less hurtful in this fever than it 
was in the fever of 1793. I administered a few drops of 
laudanum, in one case, in the form of a clyster, in a violent 
pain in the bowels, with evident advantage, before the in- 
flammatory action of the blood-vessels was subdued. In 
this way I have often obtained the composing effects of 
laudanum where it has been rejected by the stomach. But 
I gave it sparingly, and in small doses only, in the early 
stage of the fever. John Madge, whose pains in his bowels 
were often as exquisite as they are in the most acute colic, 
did not take a single drop of it. I used no anodyne in his 
Case but bleeding, and applications of cold water to the 
inside and outside of his bowels. After the fever had passed 

Vol. ii. p. 108. 



230 AN ACCOUNT OF THE 

the seventh day, and had been so far subdued by copious 
evacuations as to put on the form of a common inflamma- 
tory intermittent, I gave laudanum during the intermissions 
of the fever with great advantage. In some cases it sudden- 
ly checked the paroxysms of the fever, while in many more 
it, only moderated them, but in such a manner that they 
wore themselves away in eight or ten days. One of my 
female patients, who had taken bitters of every kind with- 
out effect to cure a tertian, which succeeded a yellow fever, 
took a large dose of laudanum, in the interval of her parx- 
ysms, to cure a tooth-ach. To her great surprise it remov- 
ed her tertian. The effects of laudanum in this fever were 
very different from those of bark. Where it did no service 
it did not, like the bark, do any harm. 

Perhaps this difference in the operation of those two 
medicines depended upon the bark acting with an astrin- 
gent, as well as stimulating power, chiefly upon the blood- 
vessels, while the action of opium was more simply stimu- 
lating, and diffused at the same time over all the systems of 
the body. 

I shall say in another place that I sometimes directed a 
few drops of laudanum to be given in that state of extreme 
debility which succeeds a paroxysm of the fever, with evi- 
dent advantage. 

Nitre, so useful in common inflammatory fevers, was in 
most cases so offensive to the stomach in this fever, that I 
was seldom able to give it. Where the stomach retained it 
I did not perceive it to do any service. 

Antimonials were as ineffectual as nitre in abating the 
Action of the sanguiferous system, and in producing a sweat. 
I should as soon expect to compose a storm by music, as 
to cure the yellow fever by such feeble remedies. 

Thus have I finished the history of the symptoms, origin, 
and cure of the yellow fever as it appeared in Philadelphia 
in 1794, and in the winter of 1795. The efficacy of the 
remedies which have been mentioned was established by 
almost universal success. Out of upwards of 200 patients 
to whom I was called on the first stage of the fever, be- 
tween the 12th of June, 1794, and the first of April, 1795, 
I lost but four persons, in whom the unequivocal symp- 
toms had occurred, which characterize the first grade of 
the disease. 



BILIOUS YELLOW FEVER OF 1794. 231 

It will be useful, I hope, to relate the cases of the patients 
whom I lost, and to mention the causes of their deaths. The 
first of them was Mrs. Gavin. She objected to a fifth bleed- 
ing in the paroxysm of her fever, and died from the w'ant 
of it. Her death was ascribed to the frequency of her 
bleedings by the enemies of the depleting system. It was 
said that she had been bled ten times, owing to ten marks 
of a lancet having been discovered on her arms after death, 
five of which were occasioned by unsuccessful attempts to 
bleed her. She died with the usual symptoms of congestion 
in her brain. 

Mr. Marr, to whom I was called on the first day of his 
disease, died in a paroxysm of his fever which came on in 
the middle of the seventh night after six bleedings. I had 
left him, the night before, nearly free of fever, and in 
good spirits. He might probably have been saved (humanly 
speaking) by one more bleeding in the exacerbation of 
what appeared to be the critical paroxysm of his fever. 

r. Montford of the state of Georgia, died under the 
joint care of Dr. Physick and myself. He had been cured 
by plentiful bleeding and purging, but had relapsed. He 
appeared to expire in a fainty fit in the first stage of a pa- 
roxysm of the fever. Death from this cause (which occurs 
most frequently where blood-letting is not used) is common 
in the yellow fever of the West- Indies. Dr. Bisset, in 
describing the different ways in which the disease terminates 
fatalK , says, " In a few cases the patient is carried off by 
an unexpected syncope."* 

A servant of Mr. Henry Mitchel, to whom I was called 
in the early stage of his disease, died in consequence of a 
sudden effusion in the lungs, which had been weakened by 
a previous pulmonary complaint. 

I wish the friends of bark and w r ine in the yellow fever, 
or of moderate bleeding with antimonial medicines, would 
publish an account of the number of their deaths by the 
fever, within the period I have mentioned, and with the 
same fidelity I have done. The contrast would for ever 
decide the controversy in favour of copious depletion. 
The mortality under the tonic mode of practice may easily 
bt conceived from the acknowledgment of one of the 
gentlemen who used it, but who premised it, in many cases, 

* Medical Essays and Observations, p. 28; 



232 AN ACCOUNT OF THE 

by two and three bleedings. He informed Dr. Woodhousc, 
that out of twenty-seven patients, whom he had attended in 
the yellow fever, he had saved but nine. Other practitioners 
were I believe, equally unsuccessful, in proportion to the 
number of patients whom they attended. The reader will 
not admit of many deaths having occurred from the diseases 
(formerly enumerated) to which they were ascribed, when 
he recollects that even a single death from most of them, in 
common seasons, is a rare occurrence in the practice of 
regular bred physicians. 

In answer to" the account I have given of the mortality 
of the fever of 1794, it will be said, that 30 persons died 
less in that year, than in the healthy year of 1792. To ac- 
count for this, it will be necessary to recollect that the 
inhabitants of Philadelphia were reduced in number up- 
wards of 4000, in the year 1793, and of course that the 
proportion of deaths was greater in 1794 than it was in 
1792, although the number was less. It is remarkable that 
the burials in the strangesrs' grave-yard amounted in the 
year 1792 to but 201, whereas in 1794 they were 676. 
From this it appears, that the deaths must have been very 
numerous among new comers (as they are sometimes called) 
in the year 1794, compared with common years. Now this 
will easily be accounted for, when we recollect that these 
people, who were chiefly labourers, were exposed to the 
constantly exciting causes of the disease, and that, in all 
countries, they are the principal sufferers by it. 

But in order to do justice to this comparative view of 
the mortality induced by the yellow fever in the year 1794, 
it will be necessary to examine the bill of mortality of the 
succeeding year. By this it appears that 2274, persons 
died in 1795, making 1139 more than died in 1794. The 
greatness of this mortality, I well recollect, surprized many 
of the citizens of Philadelphia, who had just passed an au- 
tumn which was not unusually sickly, and who had forgotten 
the uncommon mortality of the months of January , February, 
and March, which succeeded the autumn of 1794. 

It will probably be asked, how it came to pass that I 
attended so many more patients in this fever than any of 
my brethren. To this I answer, that, since the year 1793, 
a great proportion of my patients have consisted of stran- 
gers, and of the poor ; and as they are more exposed to the 



BILIOUS YELLOW FEVER OF 1793. 233 

disease than other people, it follows, that of the persons 
affected by the fever, a greater proportion must have fallen 
to my share as patients, than to other physicians. My ability 
to attend a greater number of patients than most of my 
brethren, was facilitated by my having at the time of the 
fever, several ingenuous and active pupils, who assisted me 
in visiting and prescribing for the sick. These pupils were, 
Ashton Alexander and Nathaniel Potter (now physicians 
at Baltimore,) John Otto (now physician in Philadelphia,) 
and Gilbert Watson (since dead of the yellow fever.) 

The antiphlogistic remedies were not successful in Phi- 
ladelphia, in the yellow fever, in my hands alone. They 
were equally, and perhaps more so, in the hands of my 
friends Dr. Griffitts, Dr. Physick, Dr. Dewees, and Dr. 
Woodhouse. 

They were moreover successful at the same time in New- 
Haven, Baltimore, and in Charleston, in South-Carolina. 
Eighteen out of twenty died of all who took bark and wine 
in New-Haven, but only one in ten of those who used the 
depicting medicines. In a letter from Dr. Brown, a phy- 
sician of eminence in Baltimore, dated November 27th, 
1794, he says, " of the many cases which fell to my care, 
two only proved mortal where I was called on the first day 
of the disease, and had an uncontrolled opportunity to fol- 
low my judgment. Where salivation took place, I had no 
case of mortality; and in two of those cases, a black vomiting 
occurred." Dr. Ramsay, of Charleston, in a letter to one of 
his friends in this city, dated October 14th, 1794, sub- 
scribes to the efficacy of the same practice in a fever which 
prevailed at that time in Charleston, and which, he says, 
resembled the yellow fever of Philadelphia in the year 
1793. 

But the success of the depleting system was not confined 
to the United States. In a letter before quoted, which I 
received from Dr. Davidson, of St. Vincents, dated July 
22d, 1794, there is the following testimony in favour of 
evacuations from the blood-vessels, bowels, and salivary 
glands : 

" Where the fever comes on with great determination to 
the head, and an affection of the stomach, in consequence 
of that determination, violent head-ach, redness of the eyes, 
turgescence of the face, impatience of light, &c. attended 

vol. in. c g 



234 AN ACCOUNT OF THE 

with a full and hard pulse, blood-letting should be employ, 
ed freely and repeatedly, cold applications should be ap- 
plied to the head, and purging medicines should be em- 
ployed. As a purge, calomel has been used with the great- 
est advantage, sometimes by itself, but most frequently 
combined with some active purgative medicine, such as 
jalap. From some peculiarity in the disease, an uncom- 
mon quantity of the calomel is necessary to affect the 
bowels and salivary glands. As I found a small quantity 
of it did not produce the effect I wished for promptly, I 
have gradually increased the quantity, until I now venture 
to give ten grains of it, combined with five of jalap, every 
two hours until stools are procured. The calomel is then 
given by itself. 

" The patients have generally an aversion to wine. The 
bark is seldom found of much advantage in this state of 
the fever, and frequently brought on a return of the vomit- 
ing. 1 preferred to it, in a remission of the symptoms, a 
vinous infusion of the quassia, which sat better upon the 
stomach." 

In the island of Jamaica, the depleting system has been 
divided. It appears from several publications in the Kings- 
ton papers that Dr. Grant had adopted blood-letting, while 
most of the physicians of the island rest the cure of the 
yellow fever upon strong mercurial purges. The ill effects 
of moderate bleeding probably threw the lancet into disre- 
pute, for the balance of success, from those publications, is 
evidently in favour of simple purging. I have no doubt 
of the truth of the above statement of the controversy be- 
tween the exclusive advocates for bleeding and purging ; 
or perhaps the superior efficacy of the latter remedy may 
be explained in the following manner. 

In warm climates, the yellow fever is generally, as it was 
in Philadelphia in the month of August and in the begin- 
ning of September, 1793, a disease of but two or three 
paroxysms. It is sometimes, I believe, only a simple 
ephemera. In these cases, purging alone is sufficient to 
reduce the system, without the aid of bleeding. It was 
found to be so until the beginning of September, in 1793, 
in most cases in Philadelphia. The great prostration of 
the system in the yellow fever, in warm weather and in hot 
climates, renders the restoration of it to a healthy state of 



BILIOUS YELLOW FEVER OF 1794. 235 

action more gradual, and of course more safe, by means of 
purging than bleeding. The latter remedy does harm, from 
the system being below the point of re-action, after the 
pressure of the blood-vessels too suddenly to preternatural 
action, without reducing them afterwards. Had bleeding 
been practised agreeably to the method described by Ri- 
verious (mentioned in the history of the fever of 1793), 
or had the fever in Jamaica run on to more than four or 
five paroxysms, it is probable the loss of blood would have 
been not only safe, but generally beneficial. I have, in the 
same history, given my reasons why moderate bleeding in 
this, as well as many other diseases, does harm. In those 
cases where it has occurred in large quantities from natural 
haemorrhages, it has always done service in the West-Indies. 
The inefficacy, and, in some cases, the evils, of moderate 
blood-letting are not confined to the yellow fever. It is 
equally ineffectual, and, in some instances, equally hurtful, 
in apoplexy, internal dropsy of the brain, pleurisy, and 
pulmonary consumption. Where all the different states of 
the pulse which indicate the loss of blood are perfectly 
understood, and blood-letting conformed in time and in 
quantity to them, it never can do harm, in any disease. It 
is only when it is prescribed empirically, without the direc- 
tion of just principles, that it has ever proved hurtful. 
Thus the fertilizing vapours of heaven, when they fall only 
in dew, or in profuse showers of rain, are either insufficient 
to promote vegetation, or altogether, destructive to it. 

There may be habits in which great and long protracted 
debility may have so far exhausted the active powers of 
the system, as to render bleeding altogether improper* in 
this disease, in a West- India climate. Such habits are 
sometimes produced in soldiers and sailors, by the hard- 
ships of a military and naval life. Bleeding in such cases, 
Dr. Davidson assures me in a letter dated from Martinique, 
February 29th, 1796, did no good. The cure was effect- 
ed, under these circumstances, by purges, and large doses 
of calomel. But where this chronic debility does not occur, 
bleeding, when properly used, can never be injurious, even 
in a tropical climate, in the yellow fever. Of this there 
arc many proofs in the writings of the most respectable 
English and French physicians. In spite of the fears and 
clamours which have been lately excited against it in 



236 AN ACCOUNT OF THE 

Jamaica, my late friend and contemporary at the college of 
Edinburgh, Dr. Broadbelt, in a letter from Spanish Town, 
dated January 6th, 1795, and my former pupil, Dr. Weston, 
in a letter from St. Ann's Bay, dated June 17th, 1793, 
both assure me, that they have used it in this fever with 
great success. Dr Weston says that he bled " copiously 
three times in twenty four hours, and thereby saved his 
patient." 

The superior advantages of the North- American mode 
of treating the yellow fever, by means of all the common 
antiphlogistic remedies, Mall appear from comparing its 
success with that of the West-India physicians, under all 
the modes of practice which have been adopted in the isl- 
ands. Dr. Desportes lost one half of all the patients he 
attended in the yellow fever in one season in St. Domingo.* 
His remedies were moderate bleeding and purging, and 
the copious use of diluting drinks. Dr. Bisset says, 
" The yellow fever is often under particular circumstances 
very fatal, carrying off four or five in seven whom it attacks, 
and sometimes, but seldom, it is so favourable as to carry 
off only one patient in five or six."f The doctor does not 
describe the practice under which this mortality takes place. 

Dr. Home, I have elsewhere remarked,^ lost " one out 
of four of his patients in Jamaica." His remedies were 
moderate bleeding and purging, and afterwards bark, wine, 
and external applications of blankets dipped in hot vinegar. 

Dr. Blane pronounces the yellow fever to be " one of 
the most fatal diseases to which the human body is subject, 
and in which human art is the most unavailing." His 
remedies were bleeding, bark, blisters, acid drinks, saline 
draughts and camomile tea. 

Dr. Chisholm acknowledges that he lost one in twelve 
of all the patients he attended in the fever of Granada. 
His principal remedy was a salivation. I shall hereafter 
show the inferiority of this single mode of depleting, to a 
combination of it with bleeding and purging. In Phila- 
delphia and Baltimore, where bleeding, purging, and sali- 
vation were used in due time, and after the manner that has 
been described, not more than one in fifty died of the 

* Vol. i. p 55. 

t Medical Essays and Observations, p. 29. 

X Account of the Yellow Fever of 1793. 



BILIOUS YELLOW FEVER OF 1794. 237 

yellow fever. It is probable that greater certainty and suc- 
cess in the treatment of this disease will not easily be 
attained, for idiosyncracy, and habits of intemperance 
which resist or divert the operation of the most proper 
remedies, a dread of the lancet, or the delay of an hour 
in the use of it, the partial application of that or any other 
remedy, the unexpected recurrence of a paroxysm of fever 
in the middle of the night, or the clandestine exhibition of 
wine or laudanum by friends or neighbours, often defeat 
the best concerted plans of cure by a physician. Heaven 
in this, as in other instances, kindly limits human power 
and benevolence, that in all situations man may remember 
dependence upon the power and goodness of his Creator. 



AN ACCOUNT 



OF 



SPORADIC CASES 

OF 

BILIOUS YELLOW FEVER, 
IN PHILADELPHIA, 

IN THE YEARS 1795 AND 1796. 



AN ACCOUNT, &c. 



IN my account of the yellow fever, as it appeared in 
Philadelphia in the year 1794, 1 took notice of several cases 
of it which occurred in the spring of the year 1795. Be- 
fore I proceed to deliver the history of this disease as it 
appeared in 1797, I shall mention the diseases and state of 
the weather which occurred during the remaining part of 
the year 1795, and the whole of the year 1796. This 
detail of facts, apparently uninteresting to the reader in the 
present state of our knowledge of epidemics, may possibly 
lead to principles at a future day. 

The month of April, 1795, was wet and cold. All the 
diseases of this month partook of the inflammatory charac- 
ter of the preceding winter and autumn, except the mea- 
sles, which were unusually mild. 

The weather in May was alternately wet, cool, and warm. 
A few cases of malignant fever occurred this month, but 
with moderate symptoms. In June the weather was cooi 
and pleasant. The measles put on more inflammatory 
symptoms than in the preceding months. I had two cases 
of mania under my care this month, and one of rheumatism, 
which were attended with intermissions and exacerbations 
every other day. 

The weather on the 19th, 20th, 21st, and 22d days of 
Jul)- was very warm, the mercury being at 90° in Fahren- 
heit's thermometer. The fevers of this month were all 
accompanied with black discharges from the bowels. Mr. 
Kittera, one of the representatives of Pennsylvania in the 
congress of the United States, in consequence of great fa- 
tigue on a warm day, was affected with the usual symptoms 
of the vcllow fever. During his illness he constantly com- 
plained of more pain in the left, than in the right side of 
his head. His pulse was more tense in his left, than in his 

VOL. III. h h 



242 AN ACCOUNT Of SPORADIC CASES OF 

right arm. During his convalescence, it was more quick 
in the left arm, than it was in the right. He was cured by 
a salivation and the loss of above 100 ounces of blood. 
His head-ach was relieved by the application of a bladder 
half filled with ice to his forehead. 

Most of the cases of bilious fever, which came under 
my notice, were attended wiih quotidian, tertian, or quartan 
intermissions. In a ,few or my patients there was a uni- 
versal rash. 

Dr. Woodhouse informed me, that he had seen several 
instances in which the yellow fever appeared in the same 
place in which some soldiers had laboured under the dy- 
sentery. These facts show the unity of fever, and the 
impracticability of a nosological arrangement of diseases. 

The cholera infantum was severe and fatal, in many in- 
stances, during this month. It yielded to blood-letting in 
a child of Mr. Conyngham, which was but four months 
old. In a child of seven weeks old which came under my 
care, I observed the coldness, chills, hot fits, and remissions 
of the bilious fever to be as distincly marked as ever I had 
seen them in adult patients. In a child of Mr. Darrach, 
aged 5 months, the discharges from the bowels were of a 
black colour. I mention these facts in support of an opinion 
I formerly published, that the cholera infantum is a bilious 
fever, and that it rises and falls in its violence with the 
bilious fever of grown persons. 

About the latter end of this month and the beginning of 
August, there were heavy showers of rain, which carried 
away fences, bridges, barns, mills, and dwelling-houses in 
many places. Several cases of bilious yellow fever occur- 
red in the month of August. In one of them it was accom- 
panied with that morbid affection in the wind-pipe which 
has been called cynanche trachealis. It was remarkable 
that sweating became a more frequent symptom of the 
fevers of this month than it had been in July. Hippocrates 
ascribed this change in the character of bilious fevers to 
rainy weather. Perhaps it was induced by the rain which 
fell in the beginning of the month, in the fevers which have 
been named. 

Among the persons affected with the yellow fever dur- 
ing this month, was William Bradford, Esq. the attorney- 
general of the United States. From a dread of the lancet 



BILIOUS YELLOW FEVER IN 1795 & 1796. 243 

Be objected to being bled in the early stage of his disease, 
in consequence of which he died on the 23d of August, 
in the 39th year of his age, amidst the tears of numerous 
friends, and the lamentations of his whole country. 

On the 30th and 31st of August, there was a fall of rain, 
which suddenly checked the fever of the season, insomuch 
that the succeeding autumnal months were uncommonly 
healthy. Several showers of rain had nearly the same 
effect in New- York, where this fever carried off, in a few 
weeks, above 700 persons. It prevailed, at the same time, 
and with great mortality, in the city of Norfolk, in Vir- 
ginia. 

In both those cities, as well as in Philadelphia, the disease 
was evidently derived from putrid exhalation. 

In the same month, the dysentery prevailed in New-Haven, 
in Connecticut, and in the same part of the town in which 
the yellow fever had prevailed the year before. The latter 
disease was said to have been imported, but the prevalence 
of the dysentery, under the above circumstances, proved 
that both diseases were of domestic origin. 

The fever, as it appeared in Philadelphia, yielded in most 
cases to depleting remedies. After purging and blood- 
letting. I gave bark, where the fever intermitted, with ad- 
vantage. It was effectual only when given in large doses. 
In one instance, it induced a spitting of blood, whicli 
obliged me to lay it aside. 

The winter of 1796 was uncommonly moderate. There 
fell a good deal of rain, but little snow. The navigation 
of the Delaware was stopped but two or three days during 
the whole season. Catarrhs were frequent, but very few 
violent or acute diseases occurred in my practice. The 
month of March and the first week in April were uncom- 
monly dry. Several cases of malignant bilious fever came 
under my care during these months;. A little girl, of five 
years old, whom I lost in this fever, became yellow in two 
hours after her death. 

The measles prevailed in April, and were of a most in- 
flammatory nature. The weather in May and June was 
uncommonly wet. The fruit was much injured, and a 
great deal of hay destroyed by it. On the 14th of June, 
General Stewart died, with all the usual symptoms of a 
fatal yellow fever. Several other cases of it, in this and in 



244 AN ACCOUNT OF SPORADIC CASES OF 

the succeeding month, proved mortal, but they excited no 
alarm in the city, as the physicians who attended them 
called them by other names. 

The rain which fell about the middle of July checked 
this fever. August, September, and October were un- 
usually healthy. A few cases of malignant sore throat 
appeared in November. They were, in all the patients that 
came under my notice, attended with bilious discharges 
from the stomach and bowels. So little rain fell during 
the autumnal months, that the wheat perished in many 
places. The weather in December was extremely cold. 
The lamps of the city were, in several instances, extin- 
guished by it, on the night of the 23d of the month, at 
which time the mercury stood at 2° below in the thermo- 
meter. 

The yellow fever prevailed this year in Charleston, in 
South-Carolina, where it was produced by putrid exhala- 
tions from the cellars of houses which had been lately 
burnt. It was said by the physicians of that place not to 
be contagious. The same fever prevailed, at the same 
time, at Wilmington, in North-Carolina, and at Newbury- 
port, in the state of Massachusetts. In the latter place, it 
was produced by the exhalation of putrid fisru, which had 
been carelessly thrown upon a whan. 



END OF VOLUME in: 



AND 



OBSERVATIONS. 



I -t . " : 

BY BENJAMIN RUSH, M. D. 

rtOFISSOR OF THE INSTITUTES AND PRACTICE OF MEDICINE AND OF CLINICAL 
PRACTICE, IN THE UNIVERSITY OF PENNSYLVANIA. 



FOUR VOLUMES IN TWO. 
VOL. IV. 



THE FOURTH EDITION. 



PHILADELPHIA 



PRINTLD FOR B. & T. KITE, No. 20, NORTU TIIIRD ST1UET. 



Griggs & Dickinioiu, Printer* 

1815. 



CONTENTS OF VOLUME IV. 



Page 

AN Account of the Bilious Remitting and Intermitting 
Yellow Fever, as it appeared in Philadelphia in 1797 3 

An Account of the Bilious Yellow Fever, as it appear- 
ed in Philadelphia in the year 1798 39 

An Account of the Bilious Yellow Fever, as it appear- 
ed in Philadelphia in the year 1799 55 

An Account of Sporadic Cases of Yellow Fever, as they 
appeared in Philadelphia in 1800 63 

An account of Sporadic Cases of Yellow Fever, as they 
appeared in Philadelphia in 1801 69 

An Account of the Measles, as they appeared in Phi- 
ladelphia in 1801 74 

An Account of the Bilious Yellow Fever, as it ap- 
peared in Philadelphia in the year 1802 77 

An Account of the Bilious Yellow Fever, as it ap- 
peared in Philadelphia in the year 1803 83 

An Account of Sporadic Cases of Yellow Fever, as 
they appeared in Philadelphia in 1804 91 

An Account of the Bilious Yellow Fever, as it appear- 
ed in Philadelphia in the year 1805 95 

An Account of the Diseases 0/I8O6, 1807, 1808 and 
1809 101 



CONTENTS 

. . Pa ge 

An Inquiry into the various sources of the usual forms 
of Summer and Autumnal Disease, in the United 
States, and the means of preventing them 107 

Facts, intended to prove the Yellow Fever not to be 
Contagious 143 

A Defence of Blood-letting, as a remedy for certain 
Diseases I73 

An Inquiry into the comparative state of medicine, in 
Philadelphia, between the years 1760 and 1766, 
and the year 1809. 227 



AN ACCOUNT 



OF THE 



BILIOUS REMITTING AND INTERMITTING 
YELLOW FEVER, 



AS IT 



APPEARED IN PHILADELPHIA, 



IN 1797. 



I 
VOL. IV. A 



AN ACCOUNT, &c. 



THE winter of 1797 was in general healthy. During 
the spring, which was cold and wet, no diseases of any con- 
sequence occurred. The spring vegetables were late in 
coming to maturity, and there were every where in the 
neighbourhood of Philadelphia scanty crops of hay. In 
June and July there fell but little rain. Dysenteries, cho- 
leras, scarlatina, and mumps, appeared in the suburbs in 
the latter month. On the 8th of July I visited Mr. Frisk, 
and on the 25th of the same month I visited Mr. Charles 
Burrel in the yellow fever, in consultation with Dr. Phy- 
sick. They both recovered by the use of plentiful depleting 
remedies. 

The weather from the 2d to the 9th of August was rainy. 
On the 1st of this month I was called to visit Mr. Natha- 
niel Lewis, in a malignant bilious fever. On the 3d I 
visited Mr. Elisha Hall, with the same disease. He had 
been ill several days before I saw him. Both these gentle- 
men died on the 6th of the month. They were both very 
yellow after death. Mr. Hall had a black vomiting on the 
day he died. 

The news of the death of these two citizens, with un- 
equivocal symptoms of yellow fever, excited a general 
alarm in the city. Attempts were made to trace it to im- 
portation, but a little investigation soon proved that it was 
derived from the foul air of a ship which had just arrived 
from Marseilles, and which discharged her cargo at Pine- 
street wharf, near the stores occupied by Mr. Lewis and 
Mr. Hall. Many other persons about the same time were 
affected with the fever from the same cause, in Water and 
Penn-streets. About the middle of the month, a ship from 
Hamburgh communicated the disease, by means of her 
foul air, to the village of Kensington. It prevailed, more- 
over, in many instances in the suburbs, and in Kensington, 
from putrid exhalations from gutters and marshy grounds, 



4 AN ACCOUNT OF THE 

at a distance from the Delaware, and from the foul ships 
which have been mentioned. Proofs of the truth of each 
of these assertions were afterwards laid before the public. 

The disease was confined chiefly to the district of South- 
wark and the village of Kensington, for several weeks. In 
September and October, many cases occurred in the city, 
but most of them were easily traced to the above sources. 

The following account of the weather, during the months 
of August, September, and October, was obtained from 
Mr. Thomas Pryor. It is different from the weather in 
1793. It is of consequence to attend to this fact, inasmuch 
as it shows that an inflammatory constitution of the atmos- 
phere can exist under different circumstances of the wea- 
ther. It likewise accounts for the variety in the symptoms 
of the fever in different years and countries. Such is the 
influence of season and climate upon the symptoms of this 
fever, that it led Dr. M'Kitterick to suppose that the yellow 
fever of Charleston, so accurately described b Dr. Lin- 
ing, in the second volume of the Physical and Literary 
Essays of Edinburgh, was a different disease from the 
yellow fever of the West- Indies.* 

* De Febre Indis-Occidentalis Maligna Flava, p. 12. 



BILIOUS YELLOW FEVER OF 1797. 

METEOROLOGICAL OBSERTATIONS, 
MADE IN PHILADELPHIA. 

AUGUST, 1797- 



DfTlier Bar 






74 76 



Winds and Weather. 



30 S. E. E. Rain in the forenoon and afternoon. 

30 X. E. by E. Cloudy, with rain in the afternoon a< • 

night. Wind E. by N. 
30 6 E. £ N. Rain in the morning, and all day and night. 
30 4 R . Rained hard all day and at night 

29 84 Wind light, S. W. Cloudy. Rain this morning. Th< 
air extremely damp ; wind shifted to N. W. Th. 
evening heavy showers, with thunder. 

30 86 W. N. W. Cloudy. 
30 4 N. W. Close day. Rain in the evening and all nighi 

Wind to E. 
29 95 E. Rain this morning, 

29 86 S. W. Cloudy morning. 

30 16 N. W. Clear. 

30 25 V. W. Clear. Rain all night. 

30 5 S. W. Cloudy. Rain in the morning. Cloudy all da\ 

Rain at night. 
29 87 S. W. Cloudy. Rain all day. 

29 9 N. W. Clear fine morning. 

30 15 N. W. Clear fine morning. 
30 24 N. W. Clear fine morning. 
30 24 N. W. Air damp. 

30 4S. W. Cloudy. Rain, with thunder at night: a fin 

shower. 
29 7 N. W. Clear. Cloudy in the evening with thunder. 
29 8 W. N. W. Fine clear morning. 

28 9 N. W. Clear to E. 
E. Small shower this morning. Hard shower at 11, 

A. M. Wind N. E. 

29 92 E. Cloudy. At noon calm. 

29 95 Calm morning and clear. 

30 5 N". E. Clear. Rain in the afternoon, with thundet . 
30 5 S. E. Rain in the morning. Rained hard in thenighi, 

with thunder, N. W. 
29 9 N. W. Fine clear morning. 

29 96 N. W. Clear. 

30 E. Clear. 

30 1 E. by S. Rain in the morning. 

30 14 S. E. Cloudy. Damp air and sultry. 



AN ACCOUNT OF THE 



SEPTEMBER, 1797. 



D Ther Bar. 



25 

26 

27 
23 
29 
30150 



10 



Winds and weather. 



S. W. Cloudy Damp air. Rain in the morning. 

N. W. Clear. Cloudy in the evening, with lightning 

to the southward. 
N. by W. Cloudy. Clear in the afternoon and night. 
W. N. W. Clear fine morning. 
N. W. Clear. Cloudy in the evening. - 

Fresh at E. Clear. Rain in the evening. 
E. Clear. Cloudy in the evening. 
N. E. Clear and cool morning. Flying clouds at noon. 
E. N. E, Clear. 

N. E. Clear fine morning. Wind fresh at N. E. aH day 
N. to E. with flying clouds. 
W. N. W. Clear cool morning. 
S. W. Cloudy. Clear in the afternoon. 
S. W. Clear. 

S. W. Rain in the morning. Cloudy in the afternoon 
N. W. Clear. 
N. W. Clear. 
E. Cloudy. Rained all day, and thunder. 

Rained very heavy at night. 
W. N. W. Clear fine morning. 
W. N. W. Clear fine morning. New moon at 9 50 

morning. 
N. E. Clear fine morning; to S. E. in the evening. 

Cloudy at night. 
N. W. Rain in the morning. Rain at night. 
N. N. E. Cloudy. 
E. by S. Clear fine morning. Cloudy at 

night. 
W. N. W. Clear fine morning ; clear all day. 
G. In the morning flying clowds. 
N\ W. Clear fine morning ; clear all day. 
W. N. W. Clear fine morning ; clear all day. 
E. Clear fine morning. 
E. Fresh. Cloudy morning. Rain in the night. 



BILIOUS YELLOW FEVER OF 1797 



OCTOBER, 1797. 



30 29 
9 50 60 39 S5 



l'her Bar 



42 



50 



N. E. Rain this morning, and great part of the day 

N. W. Clear. 

S. E. Clear. Air damp. 

W. N. W. Rain this morning. 

W. N. W. to S. by W. in the evening. Clear all day. 

White frost this morning. 

W. Clear fine morning. White frost. 

W. Cloudy. Rain in the night. 
S. Cloudy this morning ; air damp. Wind shifted to 

W N. W. Rlows fresh. 
W. TM\ W. Clear morning. Fresh at N. W. in the 



evening, 
W. N. W. 
W. N. W. 
W. N.W. 



Winds and Weather. 



48 30 



Clear. Frost this morning. 
Cloudy. 

Clear. Ice this morning. 
N. Clear fine morning. Ice this morning. 
N. E. Cloudy. 
W. N. W. Clear. 
W. N. W. Clear fine morning. 
W. N. W. Clear fine morning. 
W. N. W. Clear fine weather. 
N W. Clear fine day. 
N. E. Cloudy, Rain in the afternon and night. Blows 

fresh at N. E. 
N. E. Blows fresh (with a little rain.) Thunder in the 

night, with rain. 
N. W. Rain in the morning. 
S. W. Clear fine morning. 
N. E. Cloudy. A great deal of rain in the night. 
N E. Clear fine morning. 
W. N. W. Clear. 
Fresh at S. W. Clear. 
W. N. W. Cloudy. 
W. Cloudy. 

N. W. Clear. Hard frost this morning. 
W. S. W. Cloudy part of this day ; clear the remainder. 



8 AN ACCOUNT OF THE 

In addition to the register of the weather it may not be 
improper to add, that moschetoes were more numerous 
during the prevalence of the fever than in 1793. An un- 
usual number of ants and cock-roaches were likewise 
observed : and it was said that the martins and swallows 
disappeared, for a while, from the city and its neighbour- 
hood. 

A disease prevailed among the cats some weeks before 
the yellow fever appeared in the city. It excited a belief 
in an unwholesome state of the atmosphere, and apprehen- 
sions of a sickly fall. It generally proved fatal to them. 

After the finst week in September there were no diseases 
to be seen but yellow fever. In that part of the town which 
is between Walnut and Vine-streets it was uncommonly 
healthy. A similar retreat ot inferior diseases has been ob- 
served to tike place during the prevalence of the plague in 
London, Holland, and Germany, according to the histo- 
ries of that disease by Sydenham, Diemerbroek, Sennertus, 
and Hildanus. It appears, from the register of the wea- 
ther, that it rained during the greatest part of the day on 
the 1st of October. The effects of this rain upon the 
disease shall be mentioned hereafter. On the 10th the 
weather became cool, and on the nights of the 12th and 
13th of the month there was a frost accompanied with ice, 
which appeared to give a sudden and complete check to 
the disease. 

The reader will probably expect an account of the effects 
of this distressing epidemic upon the public mind. The 
terror of the citizens for a while was very great. Rumours 
of an opposite and contradictory nature of the increase and 
mortality of the fever were in constant circulation. A stop- 
page was put to business, and it was computed ^that about 
two thirds of the inhabitants left the city. 

The legislature of the state early passed a law, granting 
10,000 dollars for the relief of the sufferers by the fever. 
The citizens in and out of town, as also many of the citi- 
zens of our sister states, contributed more than that sum 
for the same charitable purpose. This money was issued 
by a committee appointed by the governor of the state. 
An hospital for the reception of the poor was established 
on the east side of the river Schuylkill, and amply provided 
with every thing necessary for the accommodation of the 



BILIOUS YELLOW FEVER OF 1797. O 

sick. Tents were likewise pitehed on the east side of 
Schuylkill, to which all those people were invited who were 
exposed to the danger of taking the disease, and who had 
not means to provide a more comfortable retreat for them- 
selves in the country. 

I am sorry to add that the mortal effects of the fever 
upon the minds of our citizens were confined chiefly to 
these acts of benevolence. Many of the publications in 
the newspapers upon its existence, mode of cure, and ori- 
gin partook of a virulent spirit, which ill accorded with 
die distresses of the city. It was a cause of lamentation 
likewise to many serious people, that the citizens in gene- 
ral were less disposed, than in 1793, to acknowledge the 
agency of a divine hand in their afflictions. In some a 
levity of mind appeared upon this solemn occasion. A 
worthy bookseller gave me a melanchoiy proof of this as- 
sertion, by informing me, that he had never been asked for 
playing cards so often, in the same time, as he had been 
during the prevalence of the fever. 

Philadelphia was not the only place in the United States 
which suffered by the yellow fever. It prevailed, at the 
same time, at Providence, in Rhode-Island, at Norfolk, in 
Virginia, at Baltimore, and in many of the country towns 
of New- England, New- Jersey, and Pennsylvania." 

The influenza followed the yellow fever, as it did in the 
year 1793. It made its appearance in the latter end of 
October, and affected chiefly those citizens who had been 
out of town. 

The predisposing causes of the yellow fever, in the year 
1797, were the same as in the year 1793. Strangers were 
as usual most subject to it. The heat of the body in such 
persons, in the West- Indies, has been found to be between 
three and four degrees above that of the temperature of the 
natives. This fact is taken notice of by Dr. M'Kitterick, 
and to this he ascribes, in part, the predisposition of new 
comers to the yellow fever. 

In addition to the common exciting causes of this dis- 
ease formerly enumerated, I have only to add, that it was 
induced in one of my patients by smoking a segar. He 
had not been accustomed to the use of tobacco. 

I saw no new premonitory symptoms of this fever, ex- 
cept a tooth-ach. It occurred in Dr. Physick, Dr. Cald- 

VOL. IV. B 



10 AN ACCOUNT OF THE 

well, and in my pupil, Mr. Bellenger. In Miss Elliot 
there was such a soreness in her teeth, that she could hard- 
ly close her mouth on the day in which she was attacked 
by the fever. Neither of these persons had taken mercury 
to obviate the disease. 

I shall now deliver a short account of the symptoms of 
ihe yellow fever, as they appeared in several of the different 
systems of the body. 

I. There was but little difference in the state of the pulse 
in this epidemic from what has been recorded in the fevers 
of 1793 and 1794. I perceived a pulse, in several cases, 
which felt like a soft quill which had been shattered by 
being trodden upon. It occurred in Dr. Jones and Dr. 
Dobell, and in several other persons who had been worn 
down by great fatigue, and it was, in every instance, fol- 
lowed by a fatal issue of the fever. In Dr. Jones this state 
of the pulse was accompanied with such a difficulty of 
breathing, that every breath he drew, on the day of his 
attack, he informed me, was the effort of a sigh. He died 
on the 17th of September, and on the sixth day of his 
fever. 

The action of the arteries was, as usual, very irregular 
in many cases. In some there was a distressing throbbing 
of the vessels in the brain, and in one of my patients a 
similar sensation in the bowels, but without pain. Many 
people had issues of blood from their blisters in this fever. 

I saw nothing new in the effects of the fever upon the 
liver, lungs, brain, nor upon the stomach and bowels. 

II. The excretions were distinguished by no unusual 
marks. I met with no recoveries where there were not 
black stools. They excoriated the rectum in Dr. Way. 
It was a happy circumstance where morbid bilious matter 
came away in the beginning of the disease. But it fre- 
quently resisted the most powerful cathartics until the 5th 
or 7th day of the fever, at which time it appeared rather to 
yield to the disorganization of the liver than to medicine. 
Where sufficient blood-letting had been previously used, 
the patient frequently recovered, even after the black dis- 
charges from the bowels took place in a late stage of the 
disease. 

Dr. Coxe informed me that he attended a child of seven- 
teen months old which had white stools for several days. 



BILIOUS YELLOW FEVER OF 1797. 11 

Towards the close of its disease it had black stools, and 
soon afterwards died. 

Several of my patients discharged worms during the 
fever. In one instance they were discharged from the 
mouth. 

A preternatural frequency in making pale water attend- 
ed the first attack of the disease in Mr. Joseph Fisher. 

A discharge of an unusual quantity of urine preceded a 
few hours, the death of the daughter of Mrs. Read. 

In two of my patients there was a total suppression of 
urine. In one of them it continued five days without ex- 
citing any pain. 

There was no disposition to sweat after the first and 
second days of the fever. Even in those states of the fever, 
in which the intermissions were most complete, there was 
seldom any moisture, or even softness on the skin. This 
was so characteristic of malignity in the bilious fever, that 
where I found the opposite state of the skin, towards the 
close of a paroxysm, I did not hesitate to encourage my 
patient, by assuring him that his fever was of a mild nature, 
and would most probably be safe in its issue. 

III. I saw no unusual marks of the disease in the ner- 
vous system. The mind was seldom affected by delirium 
after the loss of blood. There was a disposition to shed 
tears in two of my patients. One of them wept during 
the whole time of a paroxysm of the fever. In one case 
I observed an uncommon dulness of apprehension, with 
no other mark of a diseased state of the mind. It was in a 
man whose faculties, in ordinary health, acted with celerity 
and vigour. 

Dr. Caldwell informed me of a singular change which 
took place in the operations of his mind during his recovery 
from the fever. His imagination carried him back to an 
early period of his life, and engaged him, for a day or two, 
in playing with a bow and arrow, and in amusements of 
which he had been fond of when a boy. A similar change 
occurred in the mind of my former pupil, Dr. Fisher, 
during his convalescence from the yellow fever in 1793. 
He amused himself for two days in looking over the 
pictures of a family bible which lay in his room, and 
declared that he found the same kind of pleasure in this 
employment that he did when a child. However uninte- 



\2 AN ACCOUNT OF THE 

resting the3c facts may now appear, the time will come 
when they may probably furnish useful hints for complet- 
ing the physiology and pathology of the mind. 

Where blood-letting had not been used, patients fre- 
quently died of convulsions. 

IV. The senses of seeing and feeling were impaired in 
several cases. Mrs. Bradford's vision was so weak that 
she hardly knew her friends at her bed-side. I had great . 
pleasure in observing this alarming symptom, suddenly 
yield to the loss of four ounces of blood. 

Several persons who died of this fever did not, from the 
beginning to the end of the disease, feel any pain. I shall 
hereafter endeavour to explain the cause of this insensible 
state of the nerves. 

The appetite for food was unimpaired for three days in 
Mr. Andrew Brown, at a time when his pulse indicated a 
high grade of the fever. I heard of several persons who 
ate with avidity just before they died. 

V. Glandular swellings were very uncommon in this 
fever. I should have ascribed their absence to the copious 
use of depleting remedies in my practice, had I not been 
informed that morbid affections of the lymphatic glands 
were unknown in the city hospital, where blood-letting was 
seldom used, and where the patients, in many instances, 
died before they had time to take medicine of any kind. 

VI. The skin was cool, dry, smooth, and even shining 
in some cases. Yellowness was not universal. Those 
small red spots, which has been compared to moscheto 
bites, occurred in several of my patients. Dr. John Duffield, 
who acted as house surgeon and apothecary at the city 
hospital, informed me that he saw vibices on the skin in 
many cases, and that they were all more or less sore to the 
touch. 

VII. The blood was dissolved in a few cases. That 
appearance of the blood, which has been compared to the 
washings of flesh, was very common. It was more or less 
sizy towards the close of the disease in most cases. I have 
suspected, from this circumstance, that this mark of ordi- 
nary morbid action or inflammation was in part the effect 
of the mercury acting upon the blood-vessels. It is well 
known that sizy blood generally accompanies a salivation. 
If this conjecture be well founded, it will not militate 



BILIOUS YELLOW FEVER OF 1797. 13 

against the use of mercury in malignant fevers, for it shows 
that this valuable medicine possesses a power of changing 
an extraordinary and dangerous degree of morbid action 
in the blood-vessels to that which is more common and 
safe. I have seldom seen a yellow fever terminate fatally 
after the appearance of sizy blood. 

Dr. Stewart informed me, that in those cases in which 
the serum of the blood had a yellow colour, it imparted a 
saline taste only to his tongue. He was the more struck 
with this fact, as he perceived a strong bitter taste upon 
his skin, in a severe attack of the yellow fever in 1793. 

I proceed next to take notice of the type of the fever. 

In many cases, it appeared in the form of a remitting 
and intermitting fever. The quotidian and tertian forms 
were most common. In Mr. Robert Warton, it appeared 
in the form of a quartian. But it frequently assumed the 
character which is given of the same fever in Charleston, 
by Dr. Lining. It came on without chills, and continued 
without any remission for three days, after which the pa- 
tient believed himself to be well, and sometimes rose from 
his bed, and applied to business. On the fourth or fifth 
day, the fever returned, and unless copious evacuations had 
been used in the early stage of the disease, it generally 
proved fatal. Sometimes the powers of the system were 
depressed below the return of active fever, and the patient 
sunk away by an easy death, without pain, heat, or a quick 
pulse. I have been much puzzled to distinguish a crisis 
of the fever on the third or fourth day, from the insidious 
appearance which has been described. It deceived me in 
1793. It may be known by a pretertatural coolness in the 
skin, and languor in the pulse, by an inability to sit up 
long without fatigue or faintness, by a dull eye, and 
by great depression of mind, or such a flow of spirits as 
sometimes to produce a declaration from the patient that 
" he feels too well." Where these symptoms appear, the 
patient should be informed of his danger, and urged to the 
continuance of such remedies as are proper for him. 

The following states or forms were observable in the 
fever : 

1. In a few cases, the miasmata produced death in four 
and twenty hours, with convulsions:, coma, or apoplexy. 



14 AN ACCOUNT OF THE 

2. There were open cases, in which the pulse was full 
and tense as in a pleurisy or rheumatism, from the begin- 
ning to the end of the fever. They were generally attended 
with a good deal of pain. 

3. There were depressed or locked cases, in which there 
were a season of great debility, but little or no pain, a 
depressed and slow pulse, a cool skin, cold hands and feet, 
and obstructed excretions. 

4. There were divided or mixed cases, in which the pulse 
was active until the 4th day, after which it became depress- 
ed. All the other symtoms of the locked state of the fever 
accompanied this depressed state of the pulse. 

5. There were cases in which the pulse imparted a per- 
ception like that of a soft and shattered quill. I have ber 
fore mentioned that this state of the pulse occurred in Dr. 
Jones and Dr. Dobell. I felt it but once, and on the day 
of his attack, in the latter gentlemen, and expressed my 
opinion of his extreme danger to one of my pupils upon 
my return from visiting him. I did not meet with a case 
which terminated favourably, where I perceived this shat- 
tered pulse. A disposition to sweat occurred in this state 
of the fever. 

6. There were what Dr. Caldwell happily called walking 
cases. The patients here were flushed or pale, had a full 
or tense pulse, but complained of no pain, had a good ap- 
petite, and walked about their rooms or houses, as if they 
were but little indisposed, until a day or two, and, in some 
instances, until a few hours before they died. We speak 
of a dumb gout and dumb rheumatism ; with equal pro- 
priety, the epithet might be applied to this form of yellow 
fever in its early stage. The impression of the remote 
cause of the fever, in these cases, was beyond sensation, 
for, upon removing a part of it by bleeding or purging, 
the patients complained of pain, and the excitement of the 
muscles passed so completely into the blood-vessels and 
alimentary canal, as to convert the fever into a common 
and more natural form. These cases were always danger- 
ous, and, when neglected, generally terminated in death. 
Mr. Brown's fever came on in this insidious shape. It 
was cured by the loss of upwards of 100 ounces of blood, 
and a plentiful salivation. 



BILIOUS YELLOW FEVER OF 1797. 15 

7. There was the intermitting form in this fever. This, 
like the last, often deceived the patient, by leading him to 
suppose his disease was of a common or trifling nature. 
It prevented Mr. Richard Smith from applying for medical 
aid in an attack of the fever for several days, by which 
means it made such an impression upon his viscera, that 
depleting remedies were in vain used to cure him. He 
died in the prime of life, beloved and lamented by a nume- 
rous circle of relations and friends. 

8. There was a form of this fever in which it resembled 
the mild remittent of common seasons. It was distin- 
guished from it chiefly by the black colour of the intestinal 
evacuations. 

9. There were cases of this fever so light, that patients 
were said to be neither tick nor well ; or, in other words, 
they were sick and well half a dozen times in a day. Such 
persons walked about, and transacted their ordinary busi- 
ness, but complained of dulness, and, occasionally, of 
shooting pains in their heads. Sometimes the stomach was 
affected with sickness, and the bowels with diarrhoea or 
costiveness. All of them complained of night sweats. 
The pulse was quicker than natural, but seldom had that 
convulsive action which constitutes fever. Purges always 
brought away black stools from such patients, and this 
circumstance served to establish its relationship to the pre- 
vailing epidemic. Now and then, by neglect or improper 
treatment, it assumed a higher and more dangerous grade 
of the fever, and became fatal, but it more commonly 
yielded to nature, or to a single dose of purging physic. 

10. There were a few cases in which the skin was af- 
fected with universal yellowness, but without more pain or 
indisposition than usually occurs in the jaundice. They 
were very frequent in the year 1793, and generally pre- 
vailed in the autumn, in all places subject to bilious fever. 

12. There were chronic cases of this fever. It is from the 
want of observation that physicians limit the duration of 
the yellow fever to certain days. I have seen many instan- 
ces in which it has been protracted into what is called by 
authors a slow nervous fever. The wife of captain Peter 
Hell died with a black vomiting after an illness of nearly 
one month. Dr. Pinckard, formerly one of the physicians 
of the British army in the West-Indies, in a late visit to 



16 AN ACCOUNT OF THE 

this city informed me, that he had often seen the yellow 
fever put on a chronic form in the West- India islands. 

In delivering this detail of the various forms of the yel- 
low fever, I am aware that I oppose the opinions of many 
of my medical brethren, who ascribe to it a certain uniform 
character, which is removed beyond the influence of cli- 
mate, habit, predisposition, and the different strength and 
combinations of remote and exciting causes. This uni- 
formity in the symptoms of this fever is said to exist in 
the West- Indies, and every deviation from it in the United 
States is called by another name. The following commu- 
nication, which I received from Dr. Pinckard, will shew 
that this disease is as different in its forms in the \V est- 
Indies as it is in this country. 

" The yellow fever, as it appeared among the troops in 
in Guiana and the West-India islands, in the year 1796 
and 1797, exhibited such perpetual instability, and varied 
so incessantly in its character, that I could not discover any 
one symptom to be decidedly diagnostic ; and henee I have 
been led into an opinion that the yellow fever, so called, is 
not a distinct or specific disease, but merely an aggravated 
degree of the common remittent or bilious fever of hot 
climates, rendered irregular in form, and augmented in ma- 
lignity, from appearing in subjects unaccustomed to the 
climate. 

" Philadelphia, January 12th, 1798." 

Many other authorities equally respectable with Dr. 
Pinckard's, among whom are Pringle, Huck, and Hunter, 
might be adduced in support of the unity of bilious fever. 
But to multiply them further would be an act of homage to 
the weakness of human reason, and an acknowledgment of 
the infant state of our knowledge in medicine. As well 
might we suppose nature to be an artist, and that diseases 
were shaped by her like a piece of statuary or a suit of 
clothes, by means of a chissel, or pair of scissars, as admit 
every different form and grade of morbid action in the 
system to be a distinct disease. 

Notwithstanding the fever put on the eleven forms which 
have been described, the moderate cases were few, com- 



BILIOUS YELLOW FEVER OF 1797. 17 

pared with those of a malignant and dangerous nature. It 
was upon this account that the mortality was greater in the 
same number of patients, who were treated with the same 
remedies, than it was in the years 1793 and 1794. The 
disease, moreover, partook of a more malignant character 
than the two epidemics that have been mentioned. The 
yellow fever in Norfolk, Drs. Taylor and Hansford inform- 
ed mc, in a letter I received from them, was much more 
malignant and fatal, under equal circumstances, than it 
was in 1795. 

There were evident marks of the disease attacking more 
persons three days before, and three days after the full and 
change of the moon, and of more deaths occurring at those 
periods than at any other time. The same thing has been 
remarked in the plague by Diemerbroeck, in the fevers of 
Bengal by Dr. Balfour, and in those of Demarara by Dr. 
Pinckard. 

During the prevalence of the fever I attended the fol- 
lowing persons who had been affected by the epidemic of 
1793, viz. Dr. Physick, Thomas Learning, Thomas 
Canby, Samuel Bradford, and George Loxley, also Mrs. 
Eggar, who had a violent attack of it in the year 1794. 
Samuel Bradford was likewise affected by it in 1794. 

During my intercourse with the sick, I felt the miasmata 
of the fever operate upon my system in the most sensible 
manner. It produced languor, a pain in my head, and 
sickness at my stomach. A sighing attended me occa- 
sionally, for upwards of two weeks. This symptom left 
me suddenly, and was succeeded by a hoarseness, and, at 
times, with such a feebleness in my voice as to make 
speaking painful to me. Having observed this affection of 
the trachea to be a precursor of the fever in several cases, 
it kept me under daily apprehensions of being confined 
by it. It gradually went oft' after the first of October. 
1 ascribed my recovery from it, and a sudden diminution 
of the (.fleets of the miasmata upon my system, to a change 
produced in the atmosphere by the rain which fell on that 
day. 

The peculiar matter emitted by the breath or perspira- 
of persons affected by this fever, induced a sneezing 
in Dr. Dobell, every time he went into a sick room. 
vol. iv. c 



18 AN ACCOUNT OF THE 

Ambrose Parey says the same thing occurred to him, upon 
entering the room of patients confined by the plague. 

The gutters emitted, in many places, a sulphureous smell 
during the prevalence of the lever. Upon rubbing my 
hands together I could at any time excite a similar smell 
in them. I have taken notice of this effect of the matters 
which produced the disease upon the body, in the year 
1794. 

In order to prevent an attack of the fever, I carefully 
avoided all its exciting causes. I reduced my diet, and lived 
sparingly upon tea, coffee, milk, and the common fruits 
and garden vegetables of the season, with a small quantity 
of salted meat, and smoked herring. My drinks were 
milk and water, weak claret and water, and weak porter 
and water. I sheltered myself as much as possible from 
the rays of the sun, and from the action of the evening air, 
and accommodated my dress to the changes in the tempe- 
rature of the atmosphere. By similar means, I have reason 
to believe, many hundred people escaped the disease, who 
were constantly exposed to it. 

The number of deaths by the fever, in the months of 
August, September, and October, amounted to between 
ten and eleven hundred. In the list of the dead were nine 
practitioners of physic, several of whom were gentlemen 
of the most respectable characters. This number will be 
thought considerable when it is added, that not more than 
three or four and twenty physicians attended patients in the 
disease. Of the survivors of that number, eight were af- 
fected with the fever. This extraordinary mortality and 
sickness among the physicians must be ascribed to their 
uncommon fatigue in attending upon the sick, and to 
their inability to command their time and labours, so as 
avoid the exciting causes of the fever. 

Among the medical gentlemen whose deaths have been 
mentioned, was my excellent friend, Dr. Nicholas Way. 
I shall carry to my grave an affectionate remembrance of 
him. We passed our youth together in the study of me- 
dicine, and lived to the time of his death in the habits of 
the tenderest friendship. In the year 1794, he removed 
from Wilmington, in the Delaware state, to Philadelphia 
where his talents and manners soon introduced him into 
extensive business. His independent fortune furnished his 



BILIOUS YELLOW FEVER OF 1797. 19 

friends with arguments to advise him to retire from the city, 
upon the first appearance of the fever. But his humanity 
prevailed over the dictates of interest and the love of life. 
He was active and intelligent in suggesting and executing 
plans to arrest the progress of the disease, and to lessen the 
distresses of the poor. On the 27th of August, he was 
seized, after a ride from the country in the evening air, 
with a chilly fit and fever. 1 saw him the next day, and 
advised the usual depleting remedies. He submitted to my 
prescriptions with reluctance, and in a sparing manner, 
from an opinion that his fever was nothing but a common 
remittent. To enforce obedience to my advice, I called 
upon Dr. Griffitts to visit him with me. Our combined 
exertions to overcome his prejudices against our remedies 
were ineffectual. At two o'clock in the afternoon, on the 
sixth day of his disease, with an aching heart I saw the 
sweat of death upon his forehead, and felt his cold arm 
without a pulse. He spoke to me with difficulty : upon 
rising from his bed-side to leave him, his eyes filled with 
tears, and his countenance spoke a language which I am 
unable to describe. I promised to return in a short time, 
with a view of attending the last scene of his life. Imme- 
diately after I left his room, he wept aloud. I returned 
hastily to him, and found him in convulsions. He died a 
few hours afterwards. Had I met with no other affliction 
in the autumn of 1797 than that which I experienced from, 
this affecting scene, it would have been a severe one ; but 
it was a part only of what I suffered from the death of other 
friends, and from the malice of enemies. 

I beg the reader's pardon for this digression. It shall 
be the last time and place in which any notice shall be taken 
of my sorrows and persecutions in the course of these 
volumes. 

Soon after the citizens returned from the country, the 
governor of the state, Mr. Mifflin addressed a letter to the 
college of physicians of Philadelphia, requesting to know 
the origin, progress, and nature of the fever which had re- 
cently afflicted the city, and the means of preventing its 
return. He addressed a similar letter to me, to be com- 
municated to such gentlemen of the faculty of medicine 
as were not members of the college of physicians. 

The college, in a memorial to the legislature of the state, 



20 AN ACCOUNT OF THE 

asserted that the fever had been imported in two ships, the 
one from Havannah, the other from Port au Prince, and 
recommended, as the most effectual means of preventing 
its recurrence, a more rigid quarantine law. 

The gentlemen of the faculty of medicine, thirteen in 
number, in two letters to the governor of the state, the one 
in their private capacity, and the other after they had 
associated themselves into an " Academy of Medicine," 
asserted that the fever had originated from the putrid exha- 
lations from the gutters and streets of the city, and from 
ponds and marshy grounds in its neighbourhood ; also 
from the foul air of two ships, the one from Marseilles and 
the other from Hamburgh. They enumerated all the com- 
mon sources of malignant fevers, and recommended the 
removal of them from the city, as the most effectual method 
of preventing the return of the fever. These sources of 
fever, and the various means of destroying them, shall be 
mentioned in another place. 

I proceed now to say a few words upon the treatment 
which was used in this fever. It was, in general, the same 
as that which was pursued in the fevers of 1793 and 1794. 

I began the cure, in most cases, by bleeding, when I was 
called on the first day of the disease, and was happy in 
observing its usual salutary effects in its early stage. On 
the second day, it frequently failed of doing service, and 
on the subsequent days of the fever, I believe, it often did 
harm ; more especially if no other depleting remedy had 
preceded it. The violent action of the blood-vessels in 
this disease, when left to itself for two or three days, fills 
and suffocates the viscera with such an immense mass of 
blood, as to leave a quantity in the vessels so small, as 
barely to keep up the actions of life. By abstracting but 
a few ounces of this circulating blood, we precipitate 
death. In those cases where a doubt is entertained of such 
an engorgement of stagnating blood having taken place, it 
will always be safest to take but three or four ounces at a 
time, and repeat it four or five times a day. By this mode 
of bleeding, we give the viscera an opportunity of empty- 
ing their superfluous blood into the vessels, and thereby 
prevent their collapsing, from the sudden abstraction of 
the stimulus which remained in them. I confine this ob- 
servation upon bleeding, after the first stage of the disease, 



BILIOUS YELLOW FEVER OF 1797. 21 

only to the epidemic of 1797. It was frequently effectual 
when used for the first time after the first and second days, 
in the fevers of 1793 and 1794, and it is often useful in 
the advanced stage of the common bilious fever. The 
different and contradictory accounts of the effects of 
bleeding in the yellow fever, in the West-Indies, probably 
originate in its being used in different stages of the disease. 
Dr. Jackson, of the British army, in his late visit to Phila- 
delphia, informed me, that he had cured nineteen out of 
twenty of all the soldiers whom he attended, by copious 
bleeding, provided it was performed within six hours after 
the attack of the fever. Beyond that period, it mitigated 
its force, but seldom cured. The quantity of blood drawn 
by the doctor, in this early stage of the disease, was always 
from twenty to thirty ounces. I have said the yellow fe- 
ver of 1797 was more malignant than the fevers of 1793 
and 1794. Its resemblance to the yellow fever in the 
West- Indies, in not yielding to bleeding after the first day, 
is a proof of this assertion. 

I was struck, during my attendance upon this fever, in 
observing the analogy between its mixed form and the ma- 
lignant state of the small-pox. The fever, in both, con- 
tinues for three or four days without any remission. They 
both have a second stage, in which death usually takes 
place, if the diseases be left to themselves. By means of 
copious bleeding in their first, they are generally deprived 
of their malignity and mortality in their second stage. This 
remark, so trite in the small-pox, has been less attended to 
in the yellow fever. The bleeding in the first stage of this 
disease does not, it is true, destroy it altogether, any more 
than it destroys an eruption in the second stage of the 
small-pox, but it weakens it in such a manner that the pa- 
tient passes through its second stage without pain or danger, 
and with no other aid from medicine than what is com- 
monly derived from good nursing, proper aliment, and a 
little gently opening physic. 

It is common with those practitioners who object to 
bleeding in the yellow fever, to admit it occasionally in 
robust habits. This rule leads to great error in practice. 
From the weak action of predisposing, or exciting causes, 
the disease often exists in a feeble state in such habits, 
while from the protracted or violent operation of the same 



22 AN ACCOUNT OF THE 

causes, it appears in great force in persons of delicate con- 
stitutions. A physician, therefore, in prescribing for a 
patient in this fever, should forget the natural strength of 
his muscles, and accommodate the loss of blood wholly to 
the morbid strength of his disease. 

The quantity of blood drawn in this fever was always 
proportioned to its violence. I cured many by a single 
bleeding. A few required the loss of upwards of a hundred 
ounces of blood to cure them. The persons from whom 
that large quantity of blood was taken, were, Messieurs 
Andrew Brown, Horace Hall, George Cummins, J. Ram- 
say, and George Eyre. But I was not singular in the 
liberal and frequent use of the lancet. The following 
physicians drew the quantities of blood annexed to their 
respective names from the following persons, viz. 

Dr. Dewees 176 ounces from Dr. Physick, 

Dr. Griffitts 110 M. S. Thomson, 

Dr. Stewart 106 Mrs. M'Phail, 

Dr. Cooper 150 Mr. David Evans, 

Dr. Gillespie 103 himself. 

All the above named persons had a rapid and easy re- 
covery, and now enjoy good health. I lost but one patient 
who had been the subject of early and copious bleeding. 
His death was evidently induced by a supper of beef-stakes 
and porter, after he had exhibited the most promising signs 
of convalescence. 



OF PURGING. 

From the great difficulty that was found in discharging 
bile from the bowels, by the common modes of adminis- 
tering purges, Dr. Griffits suggested to me the propriety 
of giving large doses of calomel, without jalap or any 
other purging medicine, in order to loosen the bile from 
its close connection with the gall-bladder and duodenum, 
during the first day of the disease. This method of dis- 
charging acrid bile was found useful. I observed the same 
relief from large evacuations of foetid bile, in the epidemic 



BILIOUS YELLOW FEVER OF 1797. 23 

of 1797, that I have remarked in the fever of 1793. Mr. 
Bryce has taken notice of the same salutary effects from 
similar evacuations, in the yellow fever, on board the Bus- 
bridge Indiaman, in the year 1792. His words are : " It 
was observable, that the more dark-coloured and foetid 
such discharges were, the more early and certainly did the 
symptoms disappear. Their good effects were so instan- 
taneous, that I have often seen a man carried up on deck, 
perfectly delirious with subsultus tendinum, and in a state 
of the greatest apparent debility, who, after one or two 
copious evacuations of this kind, has returned of himself, 
and astonished at his newly acquired strength."* Very 
different are the effects of tonic remedies, when given to 
remove this apparent debility. The clown who supposes 
the crooked appearance of a stick, when thrust into a pail 
of water, to be real, does not err more against the laws of 
light, than that physician errs against a law of the animal 
economy, who mistakes the debility which arises from op- 
pression for an exhausted state of the system, and at- 
tempts to remove it by stimulating medicines. 

After unlocking the bowels by means of calomel and 
jalap, in the beginning of the fever, I found no difficulty 
afterwards in keeping them gently open by more lenient 
purges. In addition to these which I have mentioned in 
the account of the fever of 1793, I yielded to the advice of 
Dr. Griffitts, by adopting the soluble tartar, and gave small 
doses of it daily in many cases. It seldom offended the 
stomach, and generally operated, without griping, in the 
most plentiful manner. 

However powerful bleeding and purging were in the 
cure of this fever, they often required the aid of a saliva- 
tion to assist them in subduing it. 

Besides the usual methods of introducing mercury into 
the system, Dr. Stewart accelerated its action, by obliging 
his patients to wear socks filled with mercurial ointment ; 
and Dr. Gillespie aimed at the same thing, by injecting the 
ointment, in a suitable vehicle, into the bowels, in the form 
of glysters. 

The following fact, communicated to me by Dr. Stew- 
art, will shew the safety of large doses of calomel in 
this fever. Mrs. M'Phail took 60 grains of calomel, by 
mistake, at a dose, after having taken three or four doses, 
* Annals of Medicine, p. 123. 



24 AN ACCOUNT OF THE 

of 20 grains each, on the same day. She took in all, 356 
grains in six days, and yet, says the doctor, " such waa 
the state of her stomach and intestines, that that large 
quantity was retained without producing the least griping, 
or more stools than she had when she took three grains 
every two hours." 

I observed the mercury to affect the mouth and throat 
in the following ways. 1. It sometimes produced a swel- 
ling only in the throat, resembling a common inflammatory 
angina. 2. It sometimes produced ulcers upon the lips, 
cheeks, and tongue, without any discharge from the sali- 
vary glands. 3. It sometimes produced swellings and ulcers 
in the gums, and loosened the teeth without inducing a 
salivation. 4. There were instances in which the mercury 
induced a rigidity in the masseter muscles of the jaw, by 
which means the mouth was kept constantly open, or so 
much closed, as to render it difficult for the patient to take 
food, and impossible for him to masticate it. 5. It some- 
times affected the salivary glands only, producing from 
them a copious secretion and excretion of saliva. But, 6. 
It more frequently acted upon all the above parts, and it 
was then it produced most speedily its salutary effects. 7. 
The discharge of the saliva frequently took place only 
during the remission or intermission of the fever, and 
ceased with each return of its paroxysms. 8. The saliva- 
tion did not take place, in some cases, until the solution of 
the fever. This was more especially the case in those forms 
of the fever in which there was no remissions or intermis- 
sions. 9. It ceased in most cases with the fever, but it 
sometimes continued for six weeks or two months after 
the complete recovery of the patient. 10. The mercury 
rarely dislodged the teeth. Not a single instance occurred 
of a patient losing a tooth in the city hospital, where the 
physicians, Dr. J. Duffield informed me, relied chiefly upon 
a salivation for a cure of the fever. 11. Sometimes the 
mercury produced a discharge of blood with the saliva. 
Dr. Coulter, of Baltimore, gave me an account, in a letter 
dated the 17th of September, 1797, of a boy in whom a 
haemorrhage from the salivary glands, excited by calomel, 
was succeeded by a plentiful flow of saliva, which saved 
his patient. I saw no inconvenience from the mixture of 
blood with saliva in any of my patients. It occurred in 



BILIOUS YELLOW FEVER OF 1797. 25 

Dr. Caldwell, Mr. Bradford, Mr. Brown, and several 
others. 

It has been said that mercury does no service unless it 
purges or salivates. I am disposed to believe that it may- 
act as a counter stimulus to that of the miasmata of the 
yellow fever, and thus be useful without producing any 
evacuation from the bowels or mouth. It more certainly 
acts in this way, provided blood-letting has preceded its 
exhibition. I have supposed the stimulus from the remote 
causes of the yellow fever to be equal in force to five, and 
that of mercury to three. To enable the mercury to pro- 
duce its action upon the system, it is necessary to reduce 
the febrile action, by bleeding, to two and a half, or below 
it, so that the stimulus of the mercury shall transcend it. 
The safety of mercury, when introduced into the system, 
has three advantages as a stimulus over that of the matter 
which produces the fever. 1. It excites an action in the 
system preternatural only in force. It does not derange the 
natural order of actions. 2. It determines the actions 
chiefly to external parts of the body. And, 3. It fixes them, 
when it affects the mouth and throat, upon parts which are 
capable of bearing great inflammation and effusion without 
any danger to life. The stimulus which produces the 
yellow fever acts in ways the reverse of those which have 
been mentioned. It produces violent irregular or -wrong 
actions. It determines them to internal parts of the body, 
and it fixes them upon viscera which bear, with difficulty 
and danger, the usual effects of disease. A late French 
writer, Dr. Fabre, ascribed to diseases a centrifugal, and a 
centripetal direction. From what has been said it would 
seem, the former belongs to mercury, and the latter to th© 
yellow fever. 

Considering the great prejudices against blood-letting, I 
have wished to combat this fever with mercury alone. But, 
for reasons formerly given, I have been afraid to trust to it 
without the assistance of the lancet. The character of the 
fever, moreover, like that which the poet has ascribed to 
Achilles, is of " so swift, irritable, inexorable, and cruel" 
a nature, that it would be unsafe to rely exclusively upon a 
medicine which is not only of less efficacy than bleeding, 
but often slow and uncertain in its operation, more especi- 
ally upon the throat and mouth. 

VOL. IV. D 



26 AN ACCOUNT OF THE 

Let not the reader be offended at my attempts to reason. 
I am aware of the evils which the weak and perverted 
exercise of this power of the mind has introduced into 
medicine. But let us act with the same consistency upon 
this subject that we do in other things. 

We do not consign a child to its cradle for life, because 
it falls in its first unsuccessful efforts to use its legs. In 
like manner we must not abandon reason, because, in our 
first efforts to use it, we have been deceived. A single 
just principle in our science will lead to more truth, in one 
year, than whole volumes of uncombined facts will do in 
a century. 

I lost but two patients in this epidemic in whom the 
mercury excited a salivation. One of them died from the 
want of nursing ; the other by the late application of the 
remedv. 



OF EMETICS. 

It was said a practitioner, who was opposed to bleeding 
and mercury, cured this fever by means of strong emetics. 
I gave one to a man who refused to be bled. It operated 
freely, and brought on a plentiful sweat, the next day he 
arose from his bed and went to his work. On the fourth 
day he sent for me again. My son visited him, and found 
him without a pulse. He died the next day. 

I heard of two other persons who took emetics in the 
beginning of the fever, without the advice of a physician, 
both of whom died. 

Dr. Pinckard informed me, that their effects were gene- 
rally hurtful in the violent grades of the yellow fever in the 
West-Indies. The same information has since been given 
to me by Dr. Jackson. In the second and third grades of 
the bilious fever they appear not only to be safe, but 
useful. 



BILIOUS YELLOW FEVER OF 1797. 27 



OF DIET AND DRINKS. 

The advantages of a weak vegetable diet were very 
great in this fever. I found but little difficulty, in most 
cases, in having my prohibition of animal food complied 
with before the crisis of the fever, but there was often such 
a sudden excitement of the appetite for it, immediately 
afterwards, that it was difficult to restrain it. I have men- 
tioned the case of a young man, who was upon the reco- 
very, who died in consequence of supping upon beef-stakes. 
Many other instances of the mortality of this fever from a 
similar cause, I believe, occurred in our epidemic, which 
were concealed from our physicians. I am not singular in 
ascribing the death of convalescents to the too early use of 
animal food. Dr. Poissonnier has the following important 
remark upon this subject. " The physicians of Brest 
have observed, that the relapses in the malignant fever, 
which prevailed in their naval hospitals, were as much 
the effect of a fault in the diet of the sick as of the conta- 
gious air to which they were exposed, and that as many 
patients perished from this cause as from the original fever. 
For this reason light soups, with leguminous vegetables in 
them, panada, rice seasoned with cinnamon, fresh eggs, 
&c. are all that they should be permitted to eat. The use 
of flesh should be forbidden for many days after the entire 
cure of the disorder."* 

Dr. Huxham has furnished another evidence of the dan- 
ger from the premature use of animal food, in his history 
of a malignant fever which prevailed at Plymouth, in the 
year 1740. " If any one (says the doctor) made use of a 
flesh or fish diet, before he had been very well purged, and 
his recovery confirmed, he infallibly indulged himself 
herein at the utmost danger of his life."f 

In addition to the mild articles of diet, mentioned by 
Dr. Poissonnier, I found bread and milk, with a little 
water, sugar, and the pulp of a roasted apple mixed with 
it, very acceptable to my patients during their convales- 
cence. Ovstcrs were equally innocent and agreeable. Ripe 
grapes were devoured by them with avidity, in every stage 

* Maladies de ("Jens de Mer, vol. i. p. 345. 
t Epidemics, vol ii. p. 67. 



28 AN ACCOUNT OF THE 

of the fever. The season had been favourable to the per- 
fection of this pleasant fruit, and all the gardens in the 
city and neighbourhood in which it was cultivated were 
gratuitously opened by the citizens for the benefit of the 
sick. 

The drinks were, cold water, toast and water, balm tea, 
water in which jellies of different kinds had been dissolved, 
lemonade, apple water, barley and rice water, and, in cases 
where the stomach was affected with sickness or puking, 
weak porter and water, and cold camomile tea. In the 
convalescent stage of the fever, and in such of its remis- 
sions or intermissions as were accompanied with great lan- 
guor in the pulse, wine- whey, porter and water, and brandy 
and water, were taken with advantage. 

Cold water applied to the body, cool and fresh air, and 
cleanliness, produced their usual good effects in this fever. 
In the external use of cold water, care was taken to confine 
it to such cases as were accompanied with preternatural 
heat, and to forbid it in the cold fit of the fever, and in 
those cases which were attended with cold hands and feet, 
and where the disease showed a disposition to terminate, in 
its first stage, by a profuse perspiration. It has lately given 
me great pleasure to find the same practice, in the external 
use of cold water in fevers, recommended by Dr. Currie 
of Liverpool, in his medical reports of the effects of water, 
cold and warm, as a remedy in febrile diseases. Of the 
benefit of fresh air in this fever, Dr. Dawson of Tortola 
has lately furnished me with a striking instance. He in- 
formed me, that by removing patients from the low grounds 
on that island, where the fever is generated, to a neighbour- 
ing mountain, they generally recovered in a few days. 

Finding a disagreeable smell to arise from vinegar 
sprinkled upon the floor, after it had emitted all its acid 
vapour, I directed the floors of sick rooms to be sprinkled 
only with water. I found the vapour which arose frorn it 
to be more grateful to my patients. A citizen of Phila- 
delphia, whose whole family recovered from the fever, 
thought he perceived evident advantages from tubs of 
fresh water being kept constantly in the sick rooms. 



BILIOUS YELLOW FEVER OF 1797. 29 



OF STIMULATING REMEDIES. 

There were now and then remissions and intermissions 
of the fever, accompanied with such signs of danger from 
debility, as to render the exhibition of a few drops of lau- 
danum, a little wine-whey, a glass of brandy and water, 
and, in some instances, a cup of weak chicken-broth, 
highly necessary and useful. In addition to these cordial 
drinks, I directed the feet to be placed in a tub of warm 
water, which was introduced under the bed-clothes, so that 
the patient was not weakened by being raised from a hori- 
zontal posture. All these remedies were laid aside upon 
the return of a paroxysm of fever. 

I did not prescribe bark in a single case of this disease. 
An infusion of the quassia root was substituted in its room, 
in several instances, with advantage. 

Blisters were applied as usual, but, from the insensibi- 
lity of the skin, they were less effectual than applications 
of mustard to the arms and legs. It is a circumstance 
worthy of notice, that while the stomach, bowels, and even 
the large blood-vessels are sometimes in a highly excited 
state, and overcharged, as it were, with life, the whole sur- 
face of the body is in a state of the greatest torpor. To 
attempt to excite it by internal remedies is like adding fuel 
to a chimney already on fire. The excitement of the blood- 
vessels, and the circulation of the blood, can only be equa- 
lized by the application of stimulants to the skin. These, 
to be effectual, should be of the most powerful kind. 
Caustics might probably be used in such cases with advan- 
tage. I am led to this opinion by a fact communicated to 
nic by Dr. Stewart. A lighted candle, which had been 
left on the bed of a woman whom he was attending in the 
apparent last stage of the yellow fever, fell upon her breast. 
She was too insensible to feel, or too weak to remove it. 
Before her nurse came into her room, it had made a deep 
and extensive impression upon her flesh. From that time 
she revived, and in the course of a few days recovered. 
As a tonic remedy in this fever, Dr. Jackson has spoken 
to me in high terms of the good effects of riding in a car- 
riage. Patients, he informed me, who were moved with 
difficulty, after riding a few miles were able to sit up, and 



30 AN ACCOUNT OF THE 

when they returned from their excursions, were frequently 
able to walk to their beds. 

Much has been said, of late years, in favour of the ap- 
plication of warm olive oil to the body in the plague, and 
a wish has been expressed, by some people, that its efficacy 
might be tried in the yellow fever. Upon examining the 
account of this remedy, as published by Mr. Baldwin, 
three things suggest themselves to our notice. 1. That the 
oil is effectual only in the forming state of the disease ; 2. 
That the friction which is used with it contributes to excite 
the torpid vessels of the skin ; and 3. That it acts chiefly 
by depleting from the pores of the body. From the unity 
of the remedy of depletion, it is probable purging or 
bleeding might be substituted to the expensive parade of 
the sweat induced by the warm oil, and the smoke of 
odoriferous vegetables. But 1 must not conceal here, that 
there are facts which favour an idea, that oil produces a 
sedative action upon the blood-vessels, through the medium 
of the skin. Bontius says it is used in this manner in the 
East- Indies, for the cure of malignant fevers, after the 
previous use of bleeding and purging. It seems to have 
been a remedy well known among the Jews ; hence we 
find the apostle James advises its being applied to the body, 
in addition to the prayers of the elders of the church.* It 
is thus in other cases, the blessings of heaven are conveyed 
to men through the use of natural means. 

During the existence of the premonitory symptoms, and 
before patients were confined to their rooms, a gentle purge, 
or the loss of a few ounces of blood, in many hundred 
instances, prevented the formation of the fever. I did not 
meet with a single exception to this remark. 

Fevers are the affliction chiefly of poor people. To 
prevent or to cure them, remedies must be cheap, and ca- 
pable of being applied with but little attendance. From 
the affinity established by the creator between evil and its 
antidotes, in other parts of his works, I am disposed to 
l^elieve no remedy will ever be effectual in any general dis- 
ease, that is not cheap, and that cannot easily be made 
universal. 

It is to be lamented that the greatest part of all the deaths 
which occur, are from diseases that are under the power of 
* Chapter v. verse 14. 



BILIOUS YELLOW FEVER OF 1797. 31 

medicine. To prevent their fatal issue, it would seem to 
be agreeable to the order of Heaven in other things, that 
they should be attacked in their forming state. Weeds, 
vermin, public oppression, and private vice, are easily 
eradicated and destroyed, if opposed by their proper reme- 
dies, as soon as they show themselves. The principal 
obstacle to the successful use of the antidotes of malignant 
fevers, in their early stage, arises from physicians refusing 
to declare when they appear in a city, and from their prac- 
tice of calling their mild forms by other names than that 
of a mortal epidemic. 

I shall now say a few words upon the success of the 
depleting practice in this epidemic. 

From the more malignant state of the fever, and from 
the fears and prejudices that were excited against bleeding 
and mercury by means of the newspapers, the success of 
those remedies was much less than in the years 1793 and 
1794. Hundreds refused to submit to them at the time, 
and in the manner, that were necessary to render them ef- 
fectual. From the publications of a number of physicians, 
who used the lancet and mercury in their greatest extent, 
it appears that they lost but one in ten of all they attended. 
It was said of several practitioners who were opposed to 
copious bleeding, that they lost a much smaller proportion 
of their patients with the prevailing fever. Upon inquiry 
it appeared they had lost many more. To conceal their 
want of success, they said their patients had died of other 
diseases. This mode of deceiving the public began in 
1793. The men who used it did not recollect, that it is 
less in favour of a physician's skill to lose patients in 
pleurisies, colics, haemorrhages, contusions, and common 
remittents, than in a malignant yellow fever. 

Dr. Sayre attended fifteen patients in the disease, all of 
whom recovered by the plentiful use of the depleting re- 
medies. His place of residence being remote from those 
parts of the city in which the fever prevailed most, pre- 
vented his being called to a greater number of cases. 

A French physician, who bled and purged moderately, 
candidly acknowledged that he saved but three out of four 
of his patients. 

In the city hospital, where bleeding was sparingly used, 
and where the physicians depended chiefly upon a saliva- 



32 AN ACCOUNT OF THE 

tion, more than one half died of all the patients who were 
admitted. It is an act of justice to the physicians of the 
hospital to add, that many, perhaps most of their patients, 
were admitted after the first day of the disease. 

I cannot conclude this comparative view of the success 
of the different modes of treating the yellow fever, without 
taking notice, that the stimulating mode as recommended 
by Dr. Kuhn and Dr. Stevens, in the year 1793, was de- 
serted by every physician in the city. Dr. Stevens ac- 
knowledged the disease to require a different treatment 
from that whieh is required in the West-Indies ; Dr. Kuhn 
adopted the lancet and mercury in his practice ; and several 
other physicians, who had written against those remedies, 
or who had doubted of their safety, and efficacy in 1793, 
used them with confidence, and in the most liberal manner, 
in 1797. 

In the histories I have given of the yellow fevers of 
1793 and 1794, I have scattered here and there a few ob- 
servations upon their degrees of danger, and the signs of 
their favourable or unfavourable issue. I shall close the' 
present history, by collecting those observations into one 
view, and adding to them such other signs as have occur- 
red to me in observing this epidemic. 

Signs of moderate danger, and a favourable issue of the 
yellow fever. 

1. A chilly fit accompanying the attack of the fever. 
The longer this chill continues, the more favourable the 
disease. 

2. The recurrence of chills every day, or twice a day, 
or every other day, with the return of the exacerbations 
of the fever. A coldness of the whole body, at the 
above periods, without chills, a coldness with a profuse 
sweat, cold feet and hands, with febrile heat in other parts 
of the body, and a profuse sweat without chills or coldness, 
are all less favourable symptoms than a regular chilly fit, but 
they indicate less danger than their total absence during 
the course of the fever. 

3. A puking of green or yellow bile on the first day of 
the disease is favourable. A discharge of black bile, if it 
occur on the first day of the fever, is not unfavourable. 

4. A discharge of green and yellow stools. It is more 
favourable if the stools are of a dark or black colour, and 



BILIOUS YELLOW FEVER OF 1797. 33 

of a foetid and acrid nature, on the first or second day of 
the fever. 

5. A softness and moisture on the skin in the beginning 
of the fever. 

6. A sense of pain in the head, or a sudden translation 
of pain from internal to external parts of the body, par- 
ticularly to the back. An increase of pain after bleeding. 

7. A sore mouth. 

8. A moist white, or a yellow tongue. 

9. An early disposition to spit freely, whether excited 
by nature or the use of mercury. 

10. Blood becoming sizy, after having exhibited the 
usual marks of great morbid action in the blood-vessels. 

11. Great and exquisite sensibility in the sense of feel- 
ing coming on near the close of the fever. 

12. Acute pain in the back and limbs. 

13. The appearance of an inflammatory spot on a finger 
or toe, Dr. H. M'Clen says, is favourable. It appears, 
die doctor says, as if tht cause of the fever had escaped 
by explosion. 

Signs of great danger, and of an unfavourable issue of 
the yellow fever are, 

1. An attack of the fever, suddenly succeeding great 
terror, anger, or the intemperate use of venery, or strong 
drink. 

2. The first paroxysm coming on without any premoni- 
tory symptoms, or a chilly fit. 

3. A coldness over the whole body without chills for 
two or three days. 

4. A sleepiness on the first and second days of the fever. 

5. Uncommon paleness of the face not induced by blood- 
letting. 

6. Constant or violent vomiting, without any discharge 
of bile. 

7. Obstinate costiveness, or a discharge of natural, or 
white stools ; also quick, watery stools after taking drink. 

8. A diarrhoea towards the close of the fever. I lost 
two patients, in 1797, with this symptom, who had exhi- 
bited, a few days before, signs of a recovery. Dr. Pinckard 
informed me, that it was generally attended with a. fatal 
issue in the yellow fever of the West-Indies. Diemerbroeck 

VOL. IV. E 



34 AN ACCOUNT OF THE 

declares, that '« scarcely one in a hundred recovered, with 
this symptom from the plague."* 

9. A suppression of urine. It is most alarming when 
it is without pain. 

10. A discharge of dark coloured and bloody urine. 

11. A cold, cool, dry, smooth, or shining skin. 

12. The appearance of a yellow colour in the face on 
the first or second day of the fever. 

13. The absence of pain, or a sudden cessation of it, 
with the common symptoms of great danger. 

14.' A disposition to faint upon a little motion, and 
fainting after losing but a few ounces of blood. 

15. A watery, glassy, or brilliant eye. A red eye on 
the fourth or fifth day of the disease. It is more alarming 
if it become so after having been previously yellow. 

16 Imperfect vision, and blindness in the close of the 
disease. 

17. Deafness. 

18. A preternatural appetite, more especially in the last 
-stage of the fever. 

19. A slow, intermitting, and shattered pulse. 

20. Great restlessness, delirium, and long continued 
coma. 

21. A discharge of coffee coloured or black matter 
from the stomach, after the fourth day of the fever. 

22. A smooth red tongue, covered with a lead-coloured 
crust, while its edges are of a bright red. 

23. A dull vacant face, expressive of distress. 

24. Great insensibility to common occurrences, and an 
indifference about the issue of the disease. 

25. Uncommon serenity of mind accompanied with an 
unusually placid countenance. 

I shall conclude this head by the following remarks : 
1. The violence, danger, and probable issue of this 
fever, seem to be in proportion to the duration and force of 
the predisposing and exciting causes. However steady 
the former are in bringing on debility, and the latter in 
acting as irritants upon accumulated excitability, yet a 
knowledge of their duration and force is always useful, not 
only in forming an opinion of the probable issue of the 
fever, but in regulating the force of remedies. 

* Lib. i. cap. 15. 



BILIOUS YELLOW FEVER OF 1797. 35 

2. The signs of danger vary in different years, from the 
influence of the weather upon the disease 

3. Notwithstanding the signs of the favourable and un- 
favourable issue of the fever, are in general uniform, 
when the cure of the disease is committed to nature, or to 
tonic medicines, yet they are far from being so when the 
treatment of the fever is taken out of the hands of nature, 
and attempted by the use of depleting remedies. We often 
see patients recover with nearly all the unfavourable symp- 
toms that have been mentioned, and we sometimes see them 
die, with all those that are favourable. The words of 
Morellus, therefore, which he has applied to the plague, 
are equally true when applied to the yellow fever. " In 
the plague, our senses deceive us. Reason deceives us. 
The aphorisms of Hippocrates deceive us."* An impor- 
tant lesson may be learned from these facts, and that is, 
never to give a patient over. On the contrary, it is our 
duty in this, as well as in all other acute diseases, to dispute 
every inch of ground with death. By means of this 
practice, which is warranted by science, as well as dictated 
by humanity, the grave has often been deprived for a while 
of its prey, and prelude thereby exhibited of that approach- 
ing and delightful time foretold by ancient prophets, when 
the power of medicine over diseases shall be such, as to 
render old age the only outlet of human life. 

• 

* De Feb. Pestilent, cap. v. " Acutorum morborum incertx admodum, 
ac fallaces sunt prscUictioneB." 

Hippocrates. 



AN ACCOUNT 



OP THE 



BILIOUS YELLOW FEVER, 



AS IT 



APPEARED IN PHILADELPHIA, 



IN THB TIAH 1798. 



AN ACCOUNT, &c. 



THE yellow fever of the year 1797 was succeeded 
by scarlatina, catarrhs, and bilious pleurisies, in the months 
of November and December of the same year. The 
weather favoured the generation of the latter diseases. It 
became suddenly cold about the middle of November. On 
the 5th of December, the navigation of the Delaware was 
obstructed. There was a thaw on the 13th and 14th of 
this month, but not sufficient to open the river. 

In the month of January, 1798, the fevers discovered an 
uncommon determination to the brain. Four cases of the 
hydrocephalic state of fever occurred under my care during 
this month, all of which yielded to depleting remedies. 
The subjects of this state of fever were Mr. Robert Lewis, 
and the daughters of Messrs. John Brooks, Andrew Ellicott, 
and David Maffat. 

The weather was variable during the months of Febru- 
ary and March. The navigation of the Delaware was not 
completely opened until the latter end of February. The 
diseases of these two months were catarrhs and bilious 
pleurisies. The former were confined chiefly to children, 
and were cured by gentle pukes, purges of calomel, and 
blood-letting. The last remedy was employed twice in a 
child of Isaac Pisso, of six weeks old, and once in a child 
of Thomas Billington, of three weeks old, with success. 

On the 7th of April, I visited Mr. Pollock, lately from 
the state of Georgia, in consultation with Dr. Physick, in 
a yellow fever. He died the evening after I saw him, on 
the third day of his disease. 

There was a snow storm on the 16th of April, and the 
weather was afterwards very cold. Such leaves and blos- 
soms as had appeared, were injured by it. 

On the 1st of May, the mercury in Fahrenheit's ther- 
mometer rose to 84°. The weather, during the latter part 
of this month, and in June, was very dry. On the 6th of 



40 AN ACCOUNT OF THE 

June, Dr. Cooper lost a patient in the yellow fever, near 
the corner of Twelfth and Walnut- streets. Mark Miller 
died with the same state of fever on the 2d of July. About 
a dozen cases of a similar nature occurred, under the care 
of different practitioners, between the 2d and 20th of this 
month, and all of them in parts of the city remote from 
Water- street. 

On the 19di of July, the weather was so cool as to ren- 
der winter clothes c mfortable. A severe hail storm had 
occurred, a few days before, in the neighbourhood of Wil- 
mington, in the Delaware state. 

On the 21st of the month, the ship Deborah arrived 
from one of the West- India islands, and discharged her 
cargo in the city. She was moored afterwards at Kensing- 
ton, where the foul air which was emitted from her hold 
produced several cases of yellow fever, near the shores of 
that village. 

In August the disease appeared in nearly every part of 
the city, and particularly in places where there was the 
greatest exhalation from foul gutters and common sewers. 
In describing the disease, as it appeared this year, I shall 
take notice of its symptoms as they appeared in the blood- 
vessels, alimentary canal, the tongue, the nervous system, 
in the eyes, the lymphatic system, and the blood. 

The subjects which furnished the materials for this his- 
tory were not only private patients, but the poor in the city 
hospital, who were committed to the care of Dr. Physick 
and myself, by the board of health. 

_ I. The pulse was, in many cases, less active in the be- 
ginning of this fever than in former years. It was seldom 
preternaturally slow. It resembled the pulse which occurs 
in the first stage of the common jail fever. Haemorrhages 
were common about the fourth and fifth days, and generally 
from the gums, throat, or stomach. 

II. The whole alimentary canal was much affected in 
most cases. Costiveness and a vomiting were general. 
The alvine discharges were occasionally green, dark-co- 
loured, black, and natural. The black vomiting was more 
common this year than in former years, in all the forms of 
the fever. It was sometimes suspended for several days 
before death, and hopes were entertained of a recovery of 
patients in whom it had appeared. In a boy, at the city 



BILIOUS YELLOW FEVER OF 1798. 41 

hospital, it ceased ten days before he died. It was some- 
times succeeded by delirium or coma, but it more com- 
monly left the patient free of pain, and in the possession of 
all the faculties of his mind. 

III. The tongue was by no means an index of the state 
of the fever, as in the years 1793 and 1797. I saw several 
deaths, attended with a black vomiting, in which the tongue 
retained a natural appearance. This phenomenon at first 
deceived me. I ascribed it to such a concentration of the 
disease in the stomach and other vital parts, as to prevent 
its diffusing itself through the external parts of the system. 
We observe the effects of the same cause in a natural state 
of the skin, and in a natural appearance of the urine, in 
the most malignant forms of this fever. 

IV. In the nervous system, the disease appeared with 
several new symptoms. A relation of Peter Field attempt- 
ed to bite his attendants in the delirium of his fever, just 
before he died. 

I attended a young woman at Mrs. Easby's, who started 
every time I touched her pulse. Loud talking, or a ques- 
tion suddenly proposed to her, produced the same con- 
vulsive motion. She retained her reason during the whole 
of her illness, and was cured by bleeding and salivation. 

Hiccup was a common symptom. I saw but two 
patients recover who had it. In one of them, Dr. Hedges, 
it came on after the sixth day of the fever, and continued 
without any other symptom of disease, for four or five 
days. 

I lost a patient who complained of no pain but in the calves 
of his legs. Dr. Physick lost a girl, in the city hospital, 
who complained only of pains in her toes. Her stomach 
discovered, after death, strong marks of inflammation. 

Many people passed through every stage of the disease, 
without uttering a complaint of pain of any kind. 

An uncommon stiffness in the limbs preceded death a 
few hours, in several cases. This stiffness ceased, in one 
of Dr. Physick's patients, immediately after death, but 
returned as soon as he became cold. 

An obstinate wakefulness continued through the whole 
of the disease in Dr. Leib. It was common during the 
convalescence, in many cases. 

vol. iv. f 



42 AN ACCOUNT OP THI 

The whole body was affected, in many cases, with a 
morbid sensibility, or what has been called supersensation, 
so that patients complained of pain upon being touched, 
when they were moved in their beus. Tins extreme stnsi- 
bility was general in parts to which blisters had been ap- 
plied. It continued through every stage of the disease. 
Dr. Physick informed me, that he observed it in a man 
two hours before he died. In this man there was an ab- 
sence of pulse, and a coldness of his extremities. Upon 
touching his wrist, he cried out as if he felt great pain. 

V. A redness in the eyes was a general symptom. I 
saw few recoveries where this redness was not removed. 

A Discharge of matter from one ear relieved Mr. J. C. 
Warren from a distressing pulsation of the arteries in his 
head. 

VI. Glandular swellings occurred in several instances. 
Two cases of them came under my notice. They both 
terminated favourably. 

VII. The blood had its usual appearances in this disease. 
In the yellow fever which prevailed at the same time in 
Boston, Dr. Rand says the blood was sizy in but one out 
of a hundred cases. 

The forms of the fever were nearly similar to those which 
have been described in the year 1797. I saw several cases 
in which the disease appeared in the form of a tertian fever. 
In one of them it terminated in death. 

The system, in many cases, was prostrated below the 
point of inflammatory re-action. These were called, by 
some practitioners, typhous fevers. It was the most dan- 
gerous and fatal form of the disease. Its frequent occur- 
rence gave occasion to remark, that our epidemic resem- 
bled the yellow fever of the West- Indies, much more than 
the fevers of 1793 and 1797. 

I attended two patients in whom the disease was pro- 
tracted nearly to the 30th day. They both recovered. 

Dr. Francis Sayre informed me, that he saw a child, in 
which the morbid affection of the wind-pipe, called cyn- 
anche trachealis, appeared with all the usual symptoms of 
yellow fever. 

I attended one case in which the force of the disease 
was weakened, in its first stage by a profuse haemorrhage 



BILIOUS YELLOW FEVJER OF 1798. 43 

Irom the bowels. This haemorrhage was followed by a 
bloody diarrhoea, which continued for four or five weeks. 

Persons of all ages and colours were affected by this 
fever. I saw a case of it in a child of six months old. In 
the blacks, it was attended with less violence and mortality 
than in white people. It affected many persons who had 
previously had it. 

The disease was excited by the same causes which 
excited it in former years. I observed a number of people 
to be affected by the fever, who lived in solitude in their 
houses, without doing any business. The system, in these 
persons, was predisposed to the disease, by the debility 
induced by ceasing to labour at their former occupations. 
It was excited in a young man by a fractured leg. He 
died five days afterwards, with a black vomiting. I ob- 
served, in several instances, an interval of four and five 
days between the debility induced upon the system by a 
predisposing, and the action of an exciting cause. Dr. 
Clark says, he has seen an interval of several weeks be- 
tween the operation of those causes, in the yellow fever, of 
Dominique. These facts are worthy of notice, as they 
lead to a protracted use of the means of obviating an attack 
of the disease. 

During my attendance upon the sick, I twice perceived 
in my system the premonitory signs of the epidemic. Its 
complete formation was prevented each time by rest, a 
moderate dose of physic, and a plentiful sweat. 

I shall now take notice of the different manner in which 
patients died of this fever. The detail may be useful, by 
unfolding new principles in the animal economy, as well as 
new facts in the history of the disease. 

1. The disease terminated in death, in some instances^ 
by means of convulsions. 

2. By delirium, which prompted to exertions and ac- 
tions similar to those which take place in madness. 

3. By profuse haemorrhages from the gums. This 
occurred in two patients of Dr. Stewart. 

4. By an incessant vomiting and hiccup. 

5. By extreme pain in the calves of the legs and toes, 
which, by destroying the excitement of the system, de- 
stroyed life. 



44 AM ACCOUNT OF THE 

6. By a total absence of pain. In this way it put an end 
to the life of Mr. Henry Hill. 

7. By a disposition to easy, and apparently natural 
sleep. I have reason to believe that Mr. Hill encouraged 
this disposition to sleep, a few hours before he died, under 
the influence of a belief that he would be refreshed by it. 
Diemerbroeck says the plague often killed in the same 
way. 

8. The mind was in many cases torpid, where no deli- 
rium attended, and death was submitted to with a degree 
of insensibility, which was often mistaken for fortitude and 
resignation. 

I shall now mention the morbid appearances exhibited 
by the bodies of persons who died of this fever, as com- 
municated to me by my friend, Dr. Physick ; being the 
result of numerous dissections made by him at the city 
hospital. 

In all of them the stomach was inflamed. The matter 
which constitutes what is called the black vomit, was found 
in the stomachs of several patients who had not discharged 
it at any time by vomiting. In some stomachs, he found 
lines which seemed to separate the living from their dead 
parts. Those parts, Though dead, were not always in a 
mortified state. They were distinguished from the living 
parts by a peculiar paleness, and by discovering a weak 
texture upon being pressed between the fingers. He ob- 
served the greatest marks of inflammation in the stomachs 
of several persons in whom there had been no vomiting, 
during the whole course of the disease. The brain in a 
few instances, discovered marks of inflammation. Water 
was now and then found in its ventricles, but always of its 
natural colour, even in those persons whose skins were 
yellow. The liver suffered but little in this disease. It 
may serve to increase our knowledge of the influence of 
local circumstances upon epidemics to remark, that this 
viscus, which was rarely diseased in the fever of Philadel- 
phia in 1798, discovered marks of great inflammation in 
the bodies which were examined by Dr. Rand and Dr. 
Warren, in the town of Boston, where the yellow fever 
prevailed at the same time it did in Philadelphia. 

The weather was hot and dry in August and September, 
during the prevalence of this fever. Its influence upon 



BILIOUS YELLOW FEVER OF 1798. 45 

animal and vegetable life are worthy of notice. Mosche. 
toes abounded, as usual in sickly seasons ; grasshoppers 
covered the ground in many places ; cabbages and other 
garden vegetables, and even fields of clover, were devoured 
by them. Peaches ripened this year three weeks sooner 
than in ordinary summers, and apples rotted much sooner 
than usual after being gathered in the autumn. Many 
fruit-trees blossomed in October, and a second crop of 
small apples and cherries were seen in November, on the 
west side of Schuylkill, near the city. Meteors were ob- 
served in several places. On the 29th of September there 
was a white frost. Its effects upon the fever were obvious 
and general. It declined, in every part of the city, to such 
a degree as to induce many people to return from the 
country. In the beginning of October the weather again 
became warm, and the disease revived. It was observable, 
that all great changes in the weather from heat to cold that 
were less than that degree which produces frost, also of 
cold to heat, increased the mortality of the fever. It spread 
most rapidly in moist weather. 

The origin of this fever was from the exhalations of 
gutters, docks, cellars, common sewers, ponds of stagna- 
ting water, and from the foul air of the ship formerly 
mentioned. 

The fever prevailed at the same time in the town of 
Chester, in Pennsylvania ; in Wilmington, in the state of 
Delaware: in New- York; in New-London, in Connecticut; 
in Windsor, in Vermont ; and in Boston ; in all which 
places its origin was traced to domestic sources. 

I shall now deliver a short account of the remedies em- 
ployed in the cure of this disease. 

I have said that the pulse was less active in this fever 
than in the fevers of former years. It was seldom, how- 
ever, so feeble as to forbid bleeding. In Dr. Mease it 
called for the loss of 162 ounces of blood, and in Mr. J. 
C. Warren for the loss of 200, by successive bleedings, 
before it was subdued- But such cases were not common. 
In most of thrni, the pulse flagged after two or three bleed- 
ings. But there were cases in which the lancet was for- 
bidden altogether. In these, the system appeared to be 
prostrated, by the force of the miasmata, below the point 
of re-action. This state of the disease manifested itself in 



46 4.X account or THE 

a weak, quick, and frequent pulse, languid eye, sighing, 
great inquietude, or great insensibility. However unsafe 
bleeding was on the first day of this fever, when it appeared 
with those symptoms, nature often performed that opera- 
tion upon herself from the gums, on the fourth or fifth day. 
I saw several pounds of blood discharged on those days, 
and in that way, with the happiest effects. It appeared to 
take place after the revival of the blood-vessels from their 
prostrated state. 

From a conviction that the system was depressed only 
in these cases, and finding that it did not rise upon blood- 
letting, I resolved to try the effects of emetics, in exciting 
and equalizing the action of the blood-vessels. The ex- 
perience I had had of the inefficacy of this remedy in 1793, 
and of its ill effects in one instance in 1797, led me to 
exhibit it with a trembling hand. I gave it for the first 
time to a son of Richard Renshaw. I had bled him but 
once, and had in vain tried to bring on a salivation. On 
the fifth day of his disease, his pulse became languid and 
slow, his skin cool, a haemorrhage had taken place from 
his gums, and he discovered a restlessness and anxiety 
which I had often seen, a few hours before death. He took 
four grains of tartar emetic, with twenty grains of calomel, 
at two doses. They operated powerfully, upwards and 
downwards, and brought away a large quantity of bile. 
The effects of this medicine were such as I wished. The 
next day he was out of danger. I prescribed the same 
medicine in many other cases with the same success. To 
several of my patients I gave two emetics in the course of 
the disease. Some of them discharged bile resembling in 
viscidity the white of an egg. But I saw one case in 
which great relief was obtained from the operation of an 
emetic, where no bile was discharged. 

In the exhibition of this remedy, I was regulated by the 
pulse. If I found it languid on the first day of the fever, 
I gave it before any other medicine. - When it was full 
and tense, I deferred it until I had reduced the pulse to the 
emetic point by bleeding and purges. I observed, with 
great pleasure, that mercury affected the mouth more 
speedily and certainly where an emetic had been adminis- 
tered, than in other cases, probably from awakening, by 
its stimulus, the sensibility of the stomach ; for such was 



BILIOUS YELLOW FEVER OF 1798. 47 

its torpor, that in one case ten grains of tartar emetic, and 
in another thirty grains, did not operate upon it, so as to 
excite even the slightest degree of nausea. 

In many cases, an emetic, given in the forming state of 
the disease, seemed to effect an immediate cure. 

Purges produced the same salutary effects that they did 
in former years. I always combined calomel with them 
in the first stage of the disease. 

A salivation was found to be the most certain remedy of 
any that was used in this fever. I did not lose a single 
patient, in whom the mercury acted upon the salivary 
glands. It was difficult to excite it in many cases, from 
the mercury being rejected by the stomach, from its pas- 
sing off by the bowels, or from its stimulus being exceeded 
by the morbid action in the blood-vessels. 

Bleeding rendered the action of the mercury upon the 
mouth more speedy and more certain, but I saw several 
cases in which a salivation was excited in the most malig- 
nant forms of the fever, where no blood had been drawn. 
It will not be difficult to explain the reason of this fact if 
we recur to what was said formerly of the prostration of 
the system in this fever. In its worst forms, there is often 
a total absence, or a feeble degree of action in the blood- 
vessels, from an excess of the stimulus of the remote cause 
of the fever. Here the mercury meets with no resistance 
in its tendency to the mouth. Bleeding in this case would 
probably do harm, by taking off a part of the pressure upon 
the system, and thereby produce a re-action in the vessels, 
that might predominate over the action of the mercury. 
The disease here does that for us by its force, which, in 
other cases, we effect by depleting remedies. 

Where the mercury showed a disposition to pass too 
rapidly through the bowels, I observed no inconvenience 
from combining it with opium, in my attempts to excite 
a salivation. The calomel was constantly aided by mer- 
curial ointment, applied by friction to different parts of the 
body. 

Now and then a salivation continued for weeks and 
months after the crisis of this fever, to the great distress of 
the patient, and injury of the credit of mercury as a remedy 
in this disease. Dr. Physick has discovered, that in these 



48 AN ACCOUNT OF THE 

cases the salivation is kept up by carious teeth or bone 
and that it is to be cured only by removing them. 

From the impracticability of exciting a salivation in all 
cases, I attempted the cure of this fever, after bleeding, by 
means of copious sweats. They succeeded in several in- 
stances where no other remedy promised or afforded any 
relief. They were excited by wrapping the patient in a 
blanket, with half a dozen hot bricks wetted with vinegar, 
and applied to different parts of the body. The sweating 
was continued for six hours, and repeated daily for four or 
five days. 

In those cases where the fever put on the form of an in- 
termittent. I gave bark after bleeding and purging with 
advantage. I gave it likewise in all those cases where the 
fever put on the type of the slow chronic fever. Laudanum 
was acceptable and useful in many cases of pain, wake- 
fulness, vomiting, and diarrhoea, after the use of depleting 
remedies. 

I applied blisters in the usual way in this fever, but I 
think with less effect than in the yellow fevers of former 
years. 

To relieve a vomiting, which was very distressing in 
many cases about the fourth and fifth days, I gave a julep, 
composed of the salt of tartar and laudanum. I also gave 
Dr. Hosack's anti-emetic medicine, composed of equal 
parts of lime-water and milk. I no not know that it saved 
any lives, but I am sure it gave ease by removing a painful 
symptom, and thus, where it did not cure, lessened the 
sufferings of the sick. 

The diet and drinks were the same in this fever as they 
were in the fevers formerly described. 

Cool air, cold water, and cleanliness produced their 
usual salutary effects in this -fever. 

I shall now deliver a short account of the symptoms 
which indicated a favourable and an unfavourable issue of 
the disease. 

It has been said,*that the signs of danger vary in this 
fever, from the influence of the weather. The autumn of 
1798 confirmed in many instances, the truth of this re- 
mark. 

* History of the Fever in 1797. 



BILIOUS YELLOW FEVER OP 1798. 49 

1 saw three recoveries after convulsions in the year 1798. 
All died who were convulsed in 1793 and 1797. 

A dry, hoarse, and sore throat was followed "by death in 
every case in which it occurred in my practice. In the 
fever of 1793 a sore throat was a favourable sign. It was 
one of the circumstances which determined me to use a 
salivation in that fever. 

The absence of pain was always a bad sign. Small 
but frequent stools, and the continuance of a redness in the 
eyes after the ample use of depleting remedies, were like- 
wise bad signs. 

An appetite for food on the fourth or fifth day of the 
fever, without a remission or cessation of the fever, was 
always unfavourable. 

A want of delicacy, in exposing parts of the body which 
are usually covered, was a bad symptom. I saw but one 
recovery where it took place. Boccacio says the same 
symptom occurred in the plague in Italy. " It suspended 
(he tells us) all modesty, so that young women, of great 
rank and delicacy, submitted to be attended, dressed, and 
even cleansed by male nurses." 

I have remarked, in another place, that but two of my 
patients recovered who had the hiccup. 

A dry tongue was a bad sign. I saw but one recovery 
where it occurred, and none where the tongue was black. 
A moist and natural tongue, where symptoms of violence 
or malignity appeared in other parts of the body, was 
always followed by a fatal issue of the disease. 

A desire to ride out, or to go home, in persons who 
were absent from their families, was in every instance 
where it took place, a fatal symptom. These desires arose 
from an insensibility to pain, or a false idea of the state of 
the disease. It existed to such a degree in some of the 
patients in the city hospital, that they often left their beds, 
and dressed themselves, in order to go home. All these 
patients died, and some of them in the act of putting on 
their clothes. 

From the history that has been given of the symptoms, 
treatment, and prognosis of this fever, we see how imper- 
fect all treatises upon epidemics must be, which are not 
connected with climate and season. As well might a tra- 

vol. IV. o 



50 AN ACCOUNT OF THE 






veller describe a foreign climate, by the state of the weather, 
or by the productions of the earth, during a single autumn, 
as a physician adopt a uniform opinion of the history, 
treatment, and prognosis of a fever, from its phenomena in 
any one country, or during a single season. 

There were three modes of practice used in this epide- 
mic. The first consisted in the exhibition of purges of 
castor oil, salts, and manna, and cooling glysters, and in 
the use of the warm bath. These remedies were prescri- 
bed chiefly by the French physicians. The second con- 
sisted in the use of mercury alone, in such doses, and in 
such a manner, as to excite a salivation. This mode was 
used chiefly by an itinerant and popular quack. The third 
mode consisted in using all the remedies which I have 
mentioned in the account of the treatment of this fever, 
and accommodating them to the state of the disease. This 
mode of practice was followed by most of the American 
physicians. 

The first mode of practice was the least successful. It 
succeeded only in such cases as would probably have 
cured themselves. 

The second mode succeeded in mild cases, and now and 
then in that malignant state of the fever, in which the ac- 
tion of the blood-vessels was so much prostrated by the 
force of the miasmata, as to permit the mercury to pass 
over them, and thus to act upon the salivary glands in the 
course of four or five days. 

The last mode was by far the most successful. It is 
worthy of notice, that the business and reputation of the 
physicians, during this epidemic, were in the inverse ratio 
of their success. The number of deaths by it amounted 
to between three and four thousand, among whom were 
three physicians, and two students of medicine. Its mor- 
tality was nearly as great as it was in 1793, and yet the 
number of people who were affected by it was four times 
as great in 1793 as it was in 1798, for, in the latter year, 
the city was deserted by nearly all its inhabitants. The 
cause of this disproportion of deaths to the number who 
were sick, was owing to the liberal and general use of the 
lancet in 1793, and to the publications in 1797 having 
excited general fears and prejudicies against it in 1798. 



BILIOUS YELLOW FEVER (fr 1798. 51 

Such was the influence of these publications, that many 
persons who had recovered from this fever in the two 
former years, by the use of depleting remedies, deserted 
the physicians who had prescribed them, and put them- 
selves under the care of physicians of opposite modes of 
practice. Most of them died. Two of them had been 
my patients, one of whom had recovered of a third attack 
of the fever under mv care. 



AN ACCOUNT 

OF THE 

BILIOUS YELLOW FEVER, 

AS IT 

APPEARED IN PHILADELPHIA, 

tw Tnu TEAR 1799. 



AN ACCOUNT, &c, 



THE diseases which succeeded the fever of 1798, 
in November and December, were highly inflammatory.' 
A catarrh was nearly universal. Several cases of sore 
throat, and one of erysipelas, came under my care in the 
month of November. The weather in December was ex- 
tremely cold. It was equally so in the beginning of Janu- 
ary, 1799, accompanied with several falls of snow. 

About the middle of the month, the weather moderated 
so much, so as to open the navigation of the Delaware. I 
met with two cases of malignant colic in the latter part of 
this month, and one of yellow fever. The last was Swen 
Warner. Dr. Physick, who attended him with me, in- 
formed me that he had, nearly at the same time, attended 
two other persons with the same disease. 

The weather was very cold, and bilious pleurisies were 
common, during the latter part of the month of February. 

March was equally cold. The newspapers contained 
accounts of the winter having been uncommonly severe in 
Canada, and in several European countries. 

The first two weeks in April were still cold. The De- 
laware, which had been frozen a second time during the 
winter, was crossed near its origin, on the ice, on the 15th 
day of this month. The diseases, though fewer than in 
the winter, were bilious and inflammatory. During this 
month, I was called to a case of yellow fever, which yield- 
ed to copious bleeding, and other depleting medicines. 

May was colder than is usual in that month, but vers 
healthy. 

In the first w r eck of June, several cases of highly bilious 
fever came under my care. In one of them, all the usual 
symptoms of the highest grade of that fever occurred. On 
the 13th of the month, Dr. Physick informed me, that he 
tad lost a patient with that disease. On the 23d of the 
same month, Joseph Ashmead, a young merchant, died 



56 AN ACCOUNT OF THJS 

of it. Several other cases of the disease occurred between 
the 20th and 29th days of the month, in different parts of 
the city. About this time, I was informed that the inha- 
bitants of Keys's-alley had predicted a return of the yellow 
fever, from the trees before their doors emitting a smell, 
exactly the same which they perceived just before the 
breaking out of that disease in 1793. 

In July, the city was alarmed, by Dr. Griffitts, with an 
account of several cases of the fever in Penn-street, near 
the water. The strictness with which the quarantine law 
had been executed, for a while rendered this account in- 
credible with many people and exposed the doctor to a 
good deal of obloquy. At length a vessel was discovered, 
that had arrived from one of the West- India islands on the 
14th of May, and one day before the quarantine law was 
put into operation, from which the disease was said to be 
derived. Upon investigating the state of this vessel, it ap- 
peared that she had arrived with a healthy crew, and that 
no person had been sick on board of her during her 
voyage. 

In the latter part of July and in the beginning of August, 
the disease gradually disappeared from every part of the 
city. This circumstance deserves attention, as it shows 
the disease did not spread by contagion. 

About this time we were informed by the news-papers, 
that dogs, geese, and other poultry, also that wild pigeons 
were sickly in many parts of the country, and that fish on 
the Susquehannah, and oysters in the Delaware bay, were 
so unpleasant that the inhabitants declined eating them. 
At the same time, flies were found dead in great numbers, 
in the unhealthy parts of the city. The weather was dry 
in August and September. There was no second crop of 
grass. The gardens yielded a scanty supply of vegetables, 
and of an inferior size and quality. Cherries were smaller 
than usual, and pear and apple-trees dropped their fruits 
prematurely, in large quantities. The peaches, which 
arrived at maturity, were small and ill tasted. The grain 
was in general abundant, and of a good quality. A fly, of 
an unusual kind, covered the potatoe fields, and devoured 
in some instances, the leaves of the potatoe. This fly has 
lately been used with success in our country, instead of the 
fly imported from Spain. It is equal to it in every respec|> 
Like the Spanish fly, it sometimes induces strangury. 



BILIOUS YELLOW FEVEtt OF 1799. 57 

About the middle of August the disease revived, and 
appeared in different parts of the city. A publication from 
the academy of medicine, in which they declared the seeds 
of the disease to spread from the atmosphere only, produ- 
ced a sudden flight of the inhabitants. In no year, since 
the prevalence of the fever, was the desertion of the city so 
general. 

I shall now add a short account of the symptoms and 
treatment of this epidemic. 

The arterial system was in most cases active. I met 
with a tense pulse in a patient after the appearance of the 
black vomiting. Delirium was less frequent in adults 
than in former years. In children there was a great deter- 
mination of the disease to the brain. 

I observed no new symptoms in the stomach and bow- 
els. One of the worst cases of the fever which I saw was 
accompanied with colic. A girl of Thomas Shortall, who 
recovered, discharged nine worms during her fever. It 
appeared in Mr. Thomas Roane, one of my pupils, in the 
form of a dysentery. 

A stiffness, sush as follows death, occurred in several 
patients in the city hospital before death. 

Miss Shortall had an eruption of pimples on her breast, 
such as I have described in the short account I gave of the 
yellow fever of 1762 in this city, in my account of the 
disease in 1793. 

The blood exhibited its usual appearances in the yellow 
fever. It was seldom sizy till towards the close of the 
disease. 

The tongue was generally whitish. Sometimes it was 
•f a red colour, and had a polished appearance. I saw no 
case of a black tongue, and but few diat were yellow before 
the seventh day of the disease. 

The type of this disease was nearly the same as described 
in 1797. It now and then appeared in the form of a quar- 
tan, in which state it generally proved fatal. It appeared 
with rheumatic pains in one of my patients. It blended 
itself with gout and small-pox. Its union with the latter 
disease was evident in two patients in the city hospital, in 
each of whom the stools were such as were discharged in 
the most malignant state of the fever. 

vol. iv. h 



58 AN ACCOUNT Of THE 

The remedies for this fever were bleeding, vomits, pur- 
ges, sweats, and a salivation and blisters. 

There were few cases that did not indicate bleeding. It 
was performed, when proper, in the usual way, and with 
its usual good effects. It was indicated as much when the 
disease appeared in the bowels as in the blood-vessels. Mr. 
Roane, in whom it was accompanied with symptoms of 
dysentery, lost nearly 200 ounces of blood by twenty.two 
bleedings. 

I found the same benefit from emetics, in this fever, 
that I did in the fever of 1798. They were never admin- 
istered except on the first day, before violent action had 
taken place in the system, or after it was moderated by one 
or two bleedings. 

Purges of calomel and jalap, also castor oil, salts, and 
injections were prescribed with their usual advantages. 

In those cases where the system was prostrated below 
the point of re-action, I began the cure by sweating. 
Blankets, with hot bricks wetted with vinegar, and the hot 
bath, as mentioned formerly, when practicable, were used 
for this purpose. The latter produced, in a boy of 14 
years of age, who came into the city hospital without a 
pulse, and with a cold skin, in a few hours, a general 
warmth and an active pulse. The determination of the 
disease to the pores was evinced in one of my patients, by 
her sweating under the use of the above-mentioned reme- 
dies, for the first time in her life. A moisture upon her 
skin had never before been induced, she informed me, evea 
by the warmest day in summer. 

The advantages of a salivation were as great as in for- 
mer years. From the efficacy of bleeding, purges, emetics, 
and sweating, I had the pleasure of seeing many recoveries 
before the mercury had time to affect the mouth. In no 
one case did I rest the cure exclusively upon any one of 
these remedies. The more numerous the outlets were to 
convey off superfluous fluids and excitement from the body, 
the more safe and certain were the recoveries. A vein, the 
gall-bladder, the bowels, the pores, and the salivary glands 
were all opened, in succession, in part, or together, accord- 
ing to circumstances, so as to give the disease every pos- 
sible chance of passing out of the body without injuring or 
destroying any of its vital parts. 



BILIOUS YELLOW PEVER OF 1799. 59 

Blisters were applied with advantage. The vomiting 
and sickness which attend this fever were relieved in many 
instances, by a blister to the stomach. 

In those cases in which the fever was protracted to the 
chronic state, bark, wine, laudanum, and aether produced 
the most salutary effects. I think I saw life recalled, in 
several cases in which it appeared to be departing, by fre- 
quent and liberal doses of the last of those medicines. The 
bark was given, with safety and advantage, after the seventh 
day, when the fever assumed the form of an intermittent. 

The following symptoms were generally favourable, viz. 
a bleeding from the mouth and gums, and a disposition to 
weep, when spoken to in any stage of the fever. 

A hoarseness arid sore throat indicated a fatal issue of 
the disease, as it did in 1798. Dr. Physick remarked, 
that all those persons who sighed after waking suddenly, 
before they were able to speak, died. 

The recurrence of a redness of the eyes, after it had 
disappeared, or of but one eye, was generally followed by 
death. I saw but one recovery with a red face. 

1 saw several persons, a few hours before death, in whom 
the countenance, tongue, voice, and pulse were perfectly 
natural. They complained of no pain, and discovered no 
distress nor solicitude of mind. Their danger was only 
to be known by the circumstances which had preceded 
this apparently healthy and tranquil state of the system. 
They had all passed through extreme suffering, and some 
of them had puked black matter. 

The success of the mode of practice I have described 
was the same as in former years, in private families ; but 
in the city hospital, which was again placed under the care 
of Dr. Physick and myself, there was a very different 
issue to it, from causes that are too obvious to be men- 
tioned. 

There were two opinions given to the public upon the 
subject of the origin of this fever ; the one by the academy 
of medicine, the other by the college of physicians. The 
former declared it to be generated in the city, from putrid 
domestic exhalations, because they saw it only in their 
vicinity, and discovered no channel by which it could have 
been derived from a foreign country ; the latter asserted it 
to be " imported, because it had been imported in former 



AN 



ACCOUNT OF SPORADIC CASES 



OF 



YELLOW FEVER, 



AS THEY 



APPEARED IN PHILADELPHIA, 



IN 1800. 



AN ACCOUNT &c. 



THE weather in the month of January was less cold 
than is common in that month. Catarrhs, the cynanche 
trachealis, and bilious pleurisies were prevalent in every 
part of it. A few cases of yellow fever occurred like- 
wise during this month. 

Several cases of erysipelas appeared in, February. 

The month of March was unusually healthy. 

The weather was warm in April, and the city as healthy 
as in March. 

It was equally so in May and June. The spring fruits 
appeared early in the latter month, in large quantities, and 
were of an excellent quality. Locusts were universal in 
June. They had not appeared since the year 1783. A 
record from the journal of the Swedish missionaries was 
published at this time, which described their appearance 
in 1715. in which year it was said to be very healthy. 

On the 14th of June there was a severe thunder gust 
with more lightning than had been known for seven years 
before. 

There fell, during all the months that have been men- 
tioned, frequent and plentiful showers of rain, which 
rendered the crops of grass luxuriant in the neighbour- 
hood of Philadelphia. 

The winds at this time were chiefly from the south- 
east. 

A few intermittents appeared in June, which yielded 
readily to the bark. 

On the 16th day of June, Dr. Physick informed me 
he had a black boy under his care with the yellow fever. 

In July, the hooping cough, cholera infantum, and 



64 AN ACCOUNT OF SPORADIC CASES 

some cases of dysentery and bilious fever appeared in the 
city. 

On the 30th of July, Dr. Pascalis informed me that he 
had lost a patient on the fifth day of a yellow fever. 

In August, the dysentery was the principal form of 
disease that prevailed in the city. 

On the 22d of this month, a woman died of the yellow 
fever in Gaskill- street, under the care of Dr. Church. 

On the 28th and 30th, there fell an unusual quantity of 
rain. The winds were south-west and north-west during 
the greatest part of the summer months. The latter was 
sometimes accompanied with rain. 

On the 11th of September, a clerk of Mr. Levi Hoi- 
lingsworth, and, on the 12th~a clerk of Mr. John Connelly, 
died with the yellow fever. 

A plentiful shower of rain fell on the night of the 21st 
of this month. 

About this time there appeared one and twenty cases of 
yellow fever in Spruce-street, between Front and Second- 
streets. They were all in the neighbourhood of putrid ex- 
halations. Fourteen of them ended fatally. 

No one of the above cases of malignant fever could be 
traced to a ship, or to a direct or indirect intercourse with 
persons affected by that disease. 

While Philadelphia was thus visited by a few sporadic 
cases only of yellow fever, it was epidemic in several of 
the cities of the United States, particularly in New-York, 
Providence, in Rhode Island, Norfolk, and Baltimore. In the 
last named place, it was publicly declared by the committee 
of health to be of domestic origin. 

The dysentery was epidemic, at the same time in several 
of the towns of Massachusetts and New-Hampshire. It 
was attended with uncommon mortality at Hanover, in the 
latter state. 

This difference in the states of health and sickness in the 
different parts of the United States must be sought for 
chiefly in the different states of the weather in those places. 
The exemption of Philadelphia from the yellow fever, as 
an epidemic, may perhaps be ascribed to the strength and 
vigour of the vegetable products of the year, which retarded 
their putrefaction; to frequent showers of rain, which 



OF YELLOW FEVER IN 1800. 65 

washed away the filth of the streets and gut f ers ; and to 
the perfection of the summer and autumnal fruits. 

The months of November and December this year 
were uncommonly healthy. During the former, several 
light shocks of earthquakes were felt in Lancaster and 
Harrisburgh, in Pennsylvania, and in Wilmington, in the 
state of Delaware. 



VOL. IV. 



AN 



ACCOUNT OF SPORADIC CASES 



OF 



YELLOW FEVER 



AS THfcY 



APPEARED IN PHILADELPHIA, 



IN 1601 



AN ACCOUNT, &c. 



THE month of January was intensely cold. In 
February it became more moderate. The diseases, during 
these two months, were catarrhs and a few pleurisies. 

In March and April there fell an unusual quantity of 
rain. The hay harvest began in the neighbourhod of 
Philadelphia on the 28th of May. A few mild cases of 
scarlatina anginosa occurred during these months. 

In June the weather was dry and healthy. 

On the 8th of July, a case of yellow fever occurred in 
the practice of Dr. Stewart. About the 15th of the 
month, a patient died with it in the Pennsylvania hospital. 
Dr. Physick informed me that he had, at the same time, 
two patients under his care with that disease. Several 
cases of the measles appeared in the south end of the 
city during this month. In every part of it, the weather 
was warm and dry in consequence of which there were 
no second crops of grass, and a smaller quantity than 
usual of summer fruits and vegetables. The winds were 
less steady than they had been for seven years. They 
blew, every two or three days, from nearly every point 
of the compass. 

On the 4th of August there fell a considerable quantity 
of rain, which was succeeded by cool and pleasant wea- 
ther. The cholera morbus was a frequent disease among 
both adults and children in the city, and the dysentery in 
several of the adjoining countries of the state. 

A number of emigrant families arrived this month from 
Ireland and Wales, who brought with them the ship 
fever. They were carefully attended, at the lazaretto and 
the city hospital, in airy rooms, by which means they did 
not propagate the disease. Contrary to its usual charac- 
ter, it partook of the remissions of the bilious fever, 
probably from the influence of the season upon it. 

In September there were a few extremely warm days. 
In the beginning and middle of the month a number oi' 



70 AN ACCOUNT OF SPORADIC CASES, &C. 

mild remittents occurred, and about the 22d there were 
five or six cases of yellow fever in Eighth-street, between 
Chesnut and Walnut-streets, in two houses ill ventilated, 
and exposed to a good deal of exhalation. I attended most 
of these cases in consultation with Dr. Gallaher. One of 
the persons who was affected with this fever puked black 
matter while I sat by his bed-side, a few hours before he 
died. 

During the summer and autumn of this year, a number 
of cases of yellow fever appeared at New-Bedford, Port- 
land, and Norwich, in the New- England states ; in New- 
York ; in some parts of New- Jersey ; and in Northampton 
and Bucks counties, in Pennsylvania. It prevailed so 
generally in New- York, as to produce a considerable de- 
sertion of the city. In none of the above places could the 
least proof be adduced of the disease being imported. In 
Philadelphia its existence was doubted or denied by most 
of the citizens, because it appeared in situations remote 
from the water, and of course could not be derived from 
any foreign source. 

It will be difficult to tell why the fever appeared only in 
sporadic cases in Philadelphia. Perhaps its prevalence as 
an epidemic was prevented by the plentiful rains in the 
spring months, by the absence uf moisture from the filth of 
the streets and gutters, in consequence of the dry weather 
in June and July, by the vigour and perfection of the pro- 
ducts of the earth, and by the variable state of the winds in 
the month of July. If none of these causes defended the 
city from more numerous cases of the yellow fever, it must 
be resolved into the want of a concurring inflammatory 
constitution of the atmosphere with the common impure 
sources of that disease. 

On the 12th of November, about twelve o'clock in the 
night, an earthquake was felt in Philadelphia, attended with 
a noise as if something heavy had fallen upon a floor. Se- 
veral cases of scarlet fever appeared in December, but the 
prevailing disease, during the two last autumnal and the 
first winter months, was the measles. I have taken notice 
that it appeared in the south end of the city in July. Dur- 
ing the months of August and September it was stationary, 
but in October, November, and December it spread 
through every part of the city. ^The following circumstances 
occurred in this epidemic, as for as it came under my notice. 



AN ACCOUNT 



OF 



THE MEASLES, 



AS THEY 



APPEARED Df PHILADELPHIA, 



IN THE YEAR 1801- 



AN ACCOUNT, &c. 



I. THE disease wore the livery of the autumnal 
fever in the following particulars. 

It was strongly marked by remissions and intermissions. 
The exacerbations came on chiefly at night. 

There were in many cases a constant nausea, and dis- 
charge of bile by puking. 

I saw one case in which the disease appeared with a 
violent cholera morbus, and several in which it was 
accompanied with diarrhoea and dysentery. 

II. Many severe cases of phrenzy, and two of cynanche 
trachealis appeared with the measles. 

III. A distressing sore mouth followed them, in a child 
of two years old, that came under my care. 

IV. A fatal hydrocephalus internus followed them in 
a boy of eight years old, whom I saw two days before he 
died. 

V. I met with a few cases in which the fever and 
eruption came on in the same day, but I saw one case 
in which the eruption did not take place until the tenth 
and another, in which it did not appear until the four- 
teenth day after the fever. 

VI. Two children had pustules on their skins, re- 
sembling the small-pox, before the eruption of the 
measles. 

VII. Many children had coughs and watery eyes, but 
without the measles. The same children had them two 
or three weeks afterwards. 

VIII. Many people who had had the measles, had 
coughs during the prevalence of the measles, resembling 
the cough which occurs in that disease. 

The remedies made use of in my practice were, 
1. Bleeding, from four to sixty ounces, according to 
the age of the patient, and the state of the pulse. This 

VOL. IV. k 



74 AN ACCOUNT OF THE &C. 

remedy relieved the cough, eased the pains in the head, 
and in one case produced, when used a third time, an 
immediate eruption of the measles. 

2. Lenient purges. 

3. Demulcent drinks. 

4. Opiates at night. 

5. Blisters. And, 

6. Astringent medicines, where a diarrhoea took place. 
I saw evident ad vantage s'from advising a vegetable diet 

to many children, as soon as any one of the families to 
which they belonged were attacked by the measles. 

I lost but one patient in this disease, and that was a 
child in convulsions. I ascribed my success to bleeding 
more generally and more copiously than I had been 
accustomed to do in the measles of former years. 



AN ACCOUNT 

OF THE 

BILIOUS YELLOW FEVER, 

AS IT 

APPEARED IN PHILADELPHIA, 

IW THE TEAR 1802. 



AN ACCOUNT, &c. 



THE weather during the month of January was 
unusually moderate and pleasant. In the latter end of it, 
many shrubs put forth leaves and blossomed. I saw a 
leaf of the honeysuckle, which was more than an inch in 
length, and above half an inch in breadth. There was 
but one fall of snow, and that a light one, during the 
whole month. 

The winds blew chiefly from the south-west in Feb- 
ruary. There was a light fall of snow on the 6th. A 
shad was caught in the Delaware, near the city, on the 
17' h On the 18th and 19th of the month, the weather 
became suddenly very cold. On the 22d there was a 
snow storm, and on the 28th, rain and a general thaw. 

In March, the weather was wet, cold, and stormy, with 
the exception of a few pleasant days. 

The scarlatina anginosa and the cynanche trachealis 
were the principal diseases that prevailed during the three 
months that have been mentioned. 

In April, there were several frosts, which destroyed 
the blossoms of the peach-trees. 

in May, the weather was so cool as to make fires 
agreeable to the last day of the month. The wind blew 
chiefly, during the whole of it, from the north-east. 

The scarlatina continued to be the reigning disease. I 
saw one fatal case of it, in which a redness only, without 
any ulcers or sloughs, appeared in the throat ; and I attend- 
ed another, in which a total immobility in the limbs was 
substituted by nature for the pain and swellings in those 
parts which generally attend the disease. There were 
three distinct grades of this epidemic. It was attended 
with such inflammatory or malignant symptoms, in some 



78 AN ACCOUNT OF THE 

instances, as to require two or three bleedings ; in others 
it appeared with a typhoid pulse, which yielded to emetics: 
turbith mineral was preferred for this purpose ; while a 
redness, without a fever, which yielded to a single purge, 
was the only symptom of it in many people. 

The weather was cool, rainy, and hot, in succession, 
in the month of June. The scarlatina continued to be 
the prevailing disease. 

During the first and second weeks in July, there fell 
a good deal of rain. On the 4th of the month I was 
called to visit Mrs. Harris, in Front- street, between Arch 
and Market-streets, with a bilious fever. The scarlatina 
had imparted to it a general redness on her skin, which 
induced her to believe it was that disease, and to neglect 
sending for medical relief for several days. She died on 
the 13th of the month, with a red eye, a black tongue, 
hiccup, and a yellow skin. Three other cases of malig. 
nant bilious fever occurred this month. Two of them 
were attended by Dr. Dewees and Dr. Otto. 

On the 15th of the month, the city was alarmed by an 
account of this fever having appeared near the corners of 
Front and Vine-streets, a part of the city which had for 
many weeks before been complained of by many people 
for emitting a foetid smell, derived from a great quantity 
of filthy matters stagnating in that neighbourhood, and 
from the foul air discharged from a vessel called the Es- 
peranza, which lay at Vine-street wharf. 

On the 2d of August, it appeared in other parts of the 
city, particularly in Front and Water- streets, near the 
draw-bridge, where it evidently originated from putrid 
sources. Reports were circulated that it was derived from 
contagion, conveyed to Vine -street wharf in the timbers 
of a vessel called the St. Domingo Packet, but faithful 
and accurate inquiries proved that this vessel had been 
detained one and twenty days, and well cleaned at the 
lazaretto, and that no one, of fourteen men who had 
worked on board of her afterwards, had been affected with 
sickness of any kind. 

On the 5th of August, the board of health publicly 
declared the fever to be contagious, and advised an imme- 
diate desertion of the city. The advice was followed with 
uncommon degrees of terror and precipitation. 



BILIOUS YELLOW FEVER OF 1802. 79 

The disease continued, in different parts of the city, 
during the whole of August and September. On the 
5th of October, the citizens were publicly invited from 
the country by the board of health. 

During this season, the yellow fever was epidemic in 
Baltimore and Wilmington. In the former place it was 
admitted by their board of health, and in the latter it 
was proved by Dr. Vaughan, to be of domestic origin. It 
prevailed, at the same time, in Sussex county and near 
Woodbury, in New-Jersey. Sporadic cases of it likewise 
occurred in New- York and Boston, and in Portsmouth, 
in New- Hampshire. The chronic fever, was epidemic 
in several of the towns of North- Carolina ; cases of fever, 
which terminated in a swelling and mortification of the 
legs, and in death on the third day, appeared on the wa- 
ters of the Juniata, in Pennsylvania; and bilious fevers, of 
a highly inflammatory grade, were likewise common near 
Germantown and Frankford, in the neighbourhood of 
Philadelphia. 

But few of the cases of yellow fever which have been 
mentioned came under my care, but I saw a considera- 
ble number of fevers of a less violent grade. They were 
the inflammatory, bilious, mild remitting, chronic, and 
intermitting fevers, and the febricula. They appeared, 
in some instances, distinct from each other, but they 
generally blended their symptoms in their different stages. 
The yellow fever often came on in the mild form of an 
intermittent, and even a febricula, and as often, after a 
single paroxysm, ended in a mild remittent or chronic 
fever. When it appeared in the latter form, it was fre- 
quently attended with a slow or low pulse, and a vomiting 
and hiccup, such as attended in the yellow fever. This 
diversity of symptoms, with which the summer and au- 
tumnal fever came on, made it impossible to decide upon 
its type on the day of its attack. Having been deceived 
in one instance, I made it a practice afterwards to watch 
every case I was called to with double vigilance, lest it 
should contract a malignant form in my hands, without 
my being prepared to meet it. Of the five original and 
obvious oases of yellow fever to which I was called, I 
saved none, for I saw but one of them before the last 



80 AN ACCOUNT OF THE, &.C. 

stage of the disease. In many others, I have reason to 
believe I prevented that malignant form of fever, by the 
early and liberal use of depleting medicines. The prac- 
tice of those physicians who attended most of the persons 
who had the yellow fever, was much less successful than 
in our former epidemics. I suspected at the time, and I 
was convinced afterwards, that it was occasioned by relying 
exclusively upon bleeding, purges, and mercury. The 
skin, in several of the cases which I saw, was covered 
with moisture. This clearly pointed out nature's attempt 
to relieve herself by sweating. Upon my mentioning this 
fact to the late Dr. Pfeiffer, jun. he instantly adopted my 
opinion, and informed me, as a reason for doing so, that he 
had heard of several whole families in the Northern Liberties, 
where the disease prevailed most, who, by attacking it in 
its forming state by profuse sweats, had cured themselves, 
without the advice of a physician. 



AN ACCOUNT 



OP THE 

BILIOUS YELLOW FEVER, 

AS IT 

APPEARED IN PHILADELPHIA, 

TK THE TKAH 1805. 



Vor. tv. 



AN ACCOUNT, &c. 



THE weather in January was uniformly cold. On 
the 21st of the month, the Delaware was completely 
frozen. 

On the 4th of February there was a general thaw, at- 
tended with a storm of hail, thunder, and lightning, which 
lasted about three quarters of an hour. The diseases of 
both these winter months were catarrhs and bilious pleuri- 
sies. The latter appeared in a tertian type. The pain in 
the side was most sensible every other day. 

The w eather was cold and dry in March, in consequence 
of which vegetation was unusually backward in April. 
The hooping cough, catarrhs and scarlatina were the dis- 
eases of this month. 

The beginning of May was very cool. There was ice 
on the 7th of the month. The winds during the greatest 
parts of this and the previous month, were from the north- 
east. 

In June, the weather was cool. Intermittents were 
common in this month, as well as in May. Such was 
the predominance of this type of fever over all other dis- 
eases, that it appeared in the form of profuse sweats, every 
other night, in a lady under the care of Dr. Dewees and 
myself, in the puerperile, without the least moisture on her 
skin. There were a few choleras this month. During the 
latter end of the month, I lost a patient with many of the. 
symptoms of yellow fever. 

The weather in July was alternately hot, moderate, and 
eool, with but little rain. The first two weeks of this 
month were healthy. A few tertian fevers occurred, which 
readily yielded to bark, without previous bleeding. Be- 
'i the 25th and 31st of the month, three deaths took 
place from the yellow fever. 



84 AN ACCOUNT OF THE 

In the month of August, the weather was the same as in 
July, except that there fell more rain in it. Mild remittents 
and cholera infantum were now common. There were 
likewise several cases of yellow fever during this month. 
One of them was in Fromberger's-court It was induced 
by the foetor of putrid fish in a cellar. A malignant dysen- 
tery was epidemic during this month in the upper part 
of Germantown, and in its neighbourhood. Several persons, 
Dr. Bensell informed me, died of it in thirty hours sick- 
ness. It prevailed, at the same time, in many parts of the 
New-England states. 

In September, cases of yellow fever appeared in different 
parts of the city, but chiefly in Water near Walnut-street. 
On the 12th of the month, the board of health published a 
declaration of its existence in the city, but said it was not 
contagious. This opinion gave great offence, for it was 
generally said to have been imported by means of a packet- 
boat from New- York, where the fever then prevailed, be- 
cause a man had sickened and died in the neighbourhood 
of the wharf where this packet was moored. It was to no 
purpose to oppose to this belief, proofs that no sick person, 
and no goods supposed to be infected, had arrived in this 
boat, and that no one of three men, who had received the 
seeds of the disease in New- York, had communicated it to 
any one of the families in Philadelphia, in which they had 
sickened and died. 

The disease assumed a new character this year, and was 
cured by a different force of medicine from that which was 
employed in some of the years in which it had prevailed in 
Philadelphia. 

I shall briefly describe it in each of the systems, and then 
take notice of some peculiarities which attended it. After- 
wards I shall mention the remedies which were effectual in 
curing it. 

1. The pulse was moderately tense in most cases. It 
intermitted in one case, and in several others the tension 
was of a transient nature. 

Haemorrhages occurred in many cases. They were 
chiefly from the nose, but in some instances they occurred 
from the stomach, bowels, and haemorrhoidal vessels. 

2. Great flatulency attended in the stomach, but sickness 
snd vomiting were much less frequent than in former years. 



BILIOUS YELLOW FEVER OF 1803. 85 

I saw but one case in which diarrhoea attended this fever. 

3. I did not meet with a single instance of a glandular 
swelling in any part of the body. 

4. There was a general disposition to sweat in this fever 
from its beginning. Two of my patients died, in whom 
no moisture could be excited on the skin. But I recovered 
one with a dry skin, by means of a purge, two bleedings, 
and blisters. 

An efflorescence on the skin occurred in several instances. 
I saw black matter discharged from a blister in one case, 
and blood in another. 

5. The stools were green and black. Bile was generally 
discharged in puking. 

6. The blood exhibited the following appearances : sizi- 
ness, lotura carnium, sunken crassamentum, red sediment, 
and what is called dense or unseparated blood. I saw no 
instance of its being dissolved. 

7. The tongue was whitish and dark-coloured. This 
diseased appearance continued, in some instances, several 
days after a recovery took place. I saw no smooth, red, 
nor black tongue, and but one dry and one natural tongue. 
The latter was followed by death. 

1 did not see a single case in which the dieease came on 
without an exciting cause ; such as light clothing and bed- 
clothes, sitting at doors after night, a long walk, gunning, 
and violent and unusual exercises of any kind. It was 
excited in a number of people by their exertions to 
extinguish a fire which took place in Water-street, be- 
tween Market and Chesnut-streets, on the morning of 
the 25th of August. I saw a fatal instance of it succeed 
a severe tooth-ach. Whether this pain was the exciting 
cause, or the first morbid symptom of the fever, I know 
not; but I was led by it to bleed a young lady twice who 
complained of that pain, and who had at the same time a 
tense pulse. Her blood had the usual appearances which 
occur in the yellow fever. 

The disease had different appearances in different parts 
of the city. It was most malignant in Water-street ; but 
in many instances it became less so, as it travelled west- 
ward, so that about Ninth-street it appeared in the form of 
a common intermittent. 

In every part of the city it often came on, as in the year 



86 AN ACCOUNT OF THE 

1802, in all the milder forms of autumnal fever formerly 
enumerated, and went off with the usual symptoms of 
yellow fever. Again, it came on with all the force and 
malignity of a yellow fever, and terminated, in a day or two, 
in a common remittent or intermittent. These modes of 
attack were so common, that it was impossible to tell what 
the character, or probable issue of a fever would be, for 
two or three days. 

The following remedies were found, very generally, to 
be effectual in this fever. 

1. Moderate bleeding. I bled but three patients three, 
and only one, four times. In general, the loss of from ten 
to twenty ounces of blood, reduced the pulse from a syno- 
cha to a synoichoid or typhoid state, and thereby prepared 
the system for other remedies. 

2. Purges were always useful. I gave calomel and 
jalap, castor oil, salts, and senna, according to the grade 
of the disease, and often according to the humour or taste 
of the patient. I aided these purges by glysters. In one 
case, where a griping and black stools attended, I directed 
injections of lime water and milk to be used with the hap- 
piest effects. ' 

3. I gave «metics in many cases with advantage but 
never while the pulse was full or tense. 

4. Having observed, as in the year 1802, a spontaneous 
moisture on the skin on the first day of the disease, in 
several cases, I was led to assist this disposition in nature 
to be relieved by the pores, by means of sweating remedies, 
but in no instance did I follow it, without previous evacu- 
ations from the blood-vessels or bowels ; for, however 
useful, the intimations of nature may be in acute diseases, 
her efforts should never be trusted to alone, inasmuch as 
they are in most causes too feeble to do service, or so vio- 
lent as to do mischief. I saw one death, and I heard of 
another, from an exclusive reliance upon spontaneous 
sweats in the beginning of this fever. The remedies I 
employed to promote this evacuation by the pores were t 
an infusion of the eupatorium perfoliatum in boiling water, 
aided by copious warm drinks, and hot bricks and blan- 
kets, applied to the external surface of the body. The 
eupatorium sometimes sickened the stomach, and puked. 



BILIOUS YELLOW FEVER OF 1803. 87 

The sweats were intermitted, and renewed two or three 
times in the eourse of four and twenty hours. 

5. 1 derived great advantage from the application of 
blisters to the wrists, before the system descended to what 
I have elsewhere called the blistering point. This was on 
the second and third days. My design, in applying them 
thus early, was to attract morbid excitement to the extre- 
mities, and thereby to create a substitute for salivation. 
They had this effect. The pain, increase of fever, and 
occasional strangury, which were produced by them, serv- 
ed like anchors to prevent the system being drifted and 
lost, by the concentration of morbid excitement in the 
stomach and brain, on the fourth, fifth, sixth, and seventh 
days of the disease. It gave me great pleasure to find, 
upon revising Dr. Home's account of the yellow fever, 
that this mode of applying blisters, in the early stage of 
the disease, was not a new one. He often applied them 
in the first stage of the fever, more especially when the 
yellow colour of the skin made its appearance on the first 
or second day. By the advice of Dr. Cheney of Jamaica, he 
was led to prefer them to the thighs, instead of the trunk 
of the body, or the legs and arms. He forbids their ever 
being applied below the calf of the legs. This caution is 
probably more necessary in the West- Indies than in the 
United States. The pain and inflammation excited by the 
blisters were mitigated by soft poultices of bread and milk. 
The strangury soon yielded to demulcent drinks, particu- 
larly to flaxseed tea. 

I was happy in not being compelled, by the violence 
or obstinacy of this fever, to resort to a salivation in or- 
der to cure it, in a single instance ; the discharges from 
the stomach and bowels, and from the veins, pores, and 
skin, have proved sufficient to convey the disease out of 
the system. 

Two persons recovered this year who had the black 
vomiting. One of them was by means of large quanti- 
ties of brandy and volatile alkali, administered by Dr. 
John Dorsey, in the city hospital ; the other was by means 
of lime and water and milk, given by an intelligent nurse 
to one of my patients, during the interval of my visits to 
her. 

From the history which has been given of the symp- 



88 AN ACCOUNT OF THE, &.C. 

toms of this fever ; from the less force of medicine that 
was necessary to subdue it ; from the safety and advantage 
of blisters in its early stage ; and from the small proportion 
which the deaths bore to the number of those who were af- 
fected, being seldom more than five in a hundred (inclu- 
ding all the grades and forms of the disease,) in the prac- 
tice of most of the physicians, it is evident this fever was 
of a less malignant nature than it had been in most of the 
years in which it had been epidemic. There was one more 
circumstance which proved its diminution of violence, and 
that was, a more feeble operation of its remote cause. In 
the year 1802, nearly all the persons who were affected 
with the fever in the neighbourhood of Vine and Water- 
streets, and in Water, between Walnut and Spruce-streets, 
died. This year, but two died of a great number who 
were sick in the former, and not one out of twelve who 
were sick in the latter place. The filth, in both parts of 
the city, was the same in both years. This difference in 
the violence and mortality of the fever was probably occa- 
sioned by a less concentrated state of the miasmata which 
produced it, or by the co-operation of a less inflammatory 
constitution of the atmosphere. 

The yellow fever was epidemic, during the summer and 
autumn of this year, in New- York, and in Alexandria, in 
Virginia. In the latter place, Dr. Dick had informed the 
public, it was derived from domestic putrefaction. 



AN 
ACCOUNT OF SPORADIC CASES 



OF 



YELLOW FEVER, 



AS THEY 



APPEARED IN PHILADELPHIA, 

IN 180*. 



VOL. IV. 



AN ACCOUNT, &c. 



THE month of January was marked by deep sno\vs 9 
lain, clear and cold weather, and by the general healthiness 
of the city. 

In February there fell a deep snow, which was followed 
by several very cold days. There was likewise a fall of 
snow in March, which was succeeded by an uncommon 
degree of cold. Catarrhs and bilious pleurisies were very 
common during both these months. 

In the beginning of April, the weather was cold and 
rainy. There were but few signs of vegetation before the 
15th of the month. Bilious pleurisies were still the prin» 
cipal diseases which prevailed in the city. 

The month of May was wet, cool, and healthy. 

In June, the winds were easterly, and the weather rainy. 
The crops of grass were luxuriant. It was remarked, 
that the milk of cows that fed upon this grass yielded 
less butter than usual, and that horses that fed upon it, 
sweated profusely with but little exercise. On the third 
of the month, I was called upon by Dr. Physick to 
visit his father, who was ill with a bilious fever. He 
died on the seventh, with a red eye, hiccup, and black 
vomiting. 

Four persons had the yellow fever in the month of July. 
One of them was in Fourth-street, between Pine and 
Lombard -streets, another was in fifth- street, between Race 
and Vine-streets, both of whom recovered. The remain- 
ing two were in the Pennsylvania hospital, both of whom 
died. Remitting and intermitting fevers were likewise 
common in this month. 

In August, those fevers assumed a chronic form. 
During this month, there died an unusual number of 
children with the cholera morbus. 

The city was uncommonly healthy in September. A 



92 AN ACCOUNT OF SPORADIC CASES, &.C. 

storm of wind and rain, from the south-east proved de- 
structive to the crops of cotton this month, on the sea 
coast of South- Carolina. 

In October, intermittents were very common between 
Eighth-street and Schuylkill. One case of yellow fever 
came under my care, in conjunction with Dr. Gallaher, on 
the western banks of that river. 

While Philadelphia and all the cities of the United 
States (Charleston excepted) were thus exempted from 
the yellow fever as an epidemic, the western parts of all 
the middle, and several of the southern states, were visited 
with the bilious fever, in all its different forms. In Dela- 
ware county, in the state of New-York, at Mill river, in 
Connecticut, and in several of the middle counties of 
Pennsylvania, it prevailed in the form of a yellow fever. 
In other parts of the United States, it appeared chiefly as 
a highly inflammatory remittent. It was so general, that 
not only whole families, but whole neighbourhoods were 
confined by it. Many suffered from the want of medical 
advice and nursing, and some from the want of even a 
single attendant. In consequence of the general preva- 
lence of this fever in some parts of Pennsylvania, the usual 
labours of the season were suspended. Apples fell and 
perished upon the ground ; no winter grain was sowed ; 
and even cows passed whole days and nights without being 
milked. 

The mortality of this fever was considerable, where 
those distressing circumstances took place. In more 
favourable circumstances, it yielded to early depletion, and 
afterwards to the bark. Relapses were frequent, from 
premature exposure to the air. Those only escaped them 
who had been salivated, by accident or design, for the cure 
of the fever. 

This disease was observed very generally to prevail 
most in high situations, which had been for years distin- 
guished for their healthiness, while the low grounds, and 
the banks of creeks and rivers, were but little affected by 
it. The unusual quantity of rain, which had fallen during 
the summer months, had produced moisture in the former 
places, which favoured putrefaction and exhalation, while 
both were prevented, in the latter places, by the grounds 
being completely covered with water. 



AN ACCOUNT 



OF TIIE 



BILIOUS YELLOW FEVER, 



AS IT 



APPEARED IN PHILADELPHIA, 



PS TOE TEA*. 1805. 



AN ACCOUNT, &c 



FOR a history of the uncommonly cold and tempestu- 
ous winter of 1804 and 1805, the reader is referred to the 
Account of the Climate of Pennsylvania, in the first 
volume of these Inquiries and Observations. 

During the months of January, February, and March, 
there were a number of bilious catarrhs and pleurisies. 

On the 7th of April, I visited a patient in the yellow 
fever with Dr. Steuart. He was cured, chiefly by copious 
bleeding. 

The weather was rainy in May. After the middle of 
June, and during the whole month of July, there fell no 
rain. The mercury in Fahrenheit fluctuated, for ten days, 
between 90° and 94°, during this month. The diseases 
which occurred in it were cholera infantum, dysenteries, a 
few common bilious, and eight cases of yellow fever. 
Three of the last were in twelfth, between Locust and 
Walnut-streets, and were first visited, on the 14th and 
15th of the month, by Dr. Hartshorn, as out-patients of 
the Pennsylvania hospital. Two of them were attended, 
about a week afterwards, by Dr. Church, in Southwark, 
and the remaining three by Dr. Rouisseau and Dr. Steuart, 
in the south end of the city. 

On the third of August, there fell a heavy shower of 
rain, but the weather, during the remaining part of the 
month, was warm and dry. The pastures were burnt up, 
and there was a great deficiency of summer vegetables in 
the neighbourhood of Philadelphia. The water in the 
Schuylkill was lower by three inches than it had been in 
the memory of a man of 70 years of age, who had lived 
antly within sight of it. 

Jn September, a number of cases of yellow fever appear- 



96 AN ACCOUNT OF THE 

ed in Southwark,* near Catharine-street. They were 
readily traced to a large bed of oysters, which had putre- 
fied on Catharine- street wharf, and which had emitted a 
most offensive exhalation throughout the whole neighbour- 
hood, for several weeks before the fever made its appear, 
ance. This exhalation proved fatal to a number of cats 
and dogs, and it now became obvious that the two eases 
of yellow fever, that were attended by Dr. Church, in the 
month of July, were derived from it. An attempt was 
made to impose a belief that they were taken by contagion 
from a ship at the lazaretto, which had lately arrived from 
the West- Indies, but a careful investigation of this tale 
proved, that neither of the two subjects of the fever had 
been on board that, nor any other ship, then under qua- 
rantine. 

The fever prevailed during the whole of this month in 
Southwark. A few cases of it appeared in the city, most 
of which were in persons who had resided in, or visited 
that district. It was brought on by weak exciting causes 
in Southwark, but the cases which originated in the city, 
required strong exciting causes to produce them. 

A heavy rain, accompanied with a good deal of wind, 
on the 28th of September, and a frost on the night of the 
7th of October, gave a considerable check to the fever. 

But few cases of it came under my care. Having per- 
ceived the same disposition in nature to relieve herself by 
the pores, that I observed in the years 1802 and 1803, my 
remedies were the same as in the latter year, and attended 
with the same success. Dr. Caldwell and Dr. Steuart, 
whose practice was extensive in Southwark, informed me 
those remedies had been generally successful in their hands. 

The only new medicine that the experience of this year 
suggested in this disease, was for one of its most dis- 
tressing and dangerous symptoms, that is, the vomiting 
which occurs in its second stage. Dr. Physick discovered, 
that ten drops of the spirit of turpentine, given every two 
hours, in a little molasses, or syrup, or sweet oil, effectu- 
ally checked it in several instances, in patients who after- 
wards recovered. It was administered with equal success 
in a case which came under my care, after an absence of 

* This extensive district is continued, from the city of Philadelphia, 
along the Delaware, but is not subject to its government. 



BILIOUS YELLOW FEVER OF 1805. 97 

pulse, and a coldness of the extremities had taken place. 
Dr. Church informed me that he gave great relief to the 
sick in the city hospital, by this medicine, by prescribing 
it in glysters, as well as by the mouth, in distressing affec- 
tions of the stomach and bowels. 

Dr. Steuart observed that all those persons who had 
been affected by the yellow fever in former years, had mild 
remittents in the same situations that others had the pre- 
vailing epidemic in a malignant form. 

In one of four bodies the Doctor examined, he found 
six, and in another three intussusceptions of the intestines, 
without any signs of inflammation. He discovered the 
common marks of disease from this fever in other parts of 
those bodies. 

The deaths from this fever amounted to between three 
and four hundred. They would probably have been more 
numerous, had not those families who were in competent 
circumstances fled into the country, and had not the poor 
been removed, by the board of health, from the infected 
atmosphere of Southwark, to tents provided for them in 
the neighbourhood of the city ; and they would probably 
have been fewer, considering the tractable nature of the 
disease, when met by suitable remedies in its early stage, 
had not the sick concealed their indisposition, in many 
instances, for two or three days, lest they should be drag- 
ged to the city hospital, or have centinels placed at their 
doors to prevent any communication with their friends and 
neighbours. While these attempts were made to check 
die" progress of the fever, it did not escape the notice of 
many of the citizens of Philadelphia, that not a single in- 
stance occurred of its being communicated by contagion, 
in any of the families in the city, in which persons had 
sickened or died with it, arid that while the sick were de- 
prived of the kind offices of their friends and neighbours, 
lest they should be infected, physicians, and the members 
of the board of health, passed by the guards every day, in 
their visits to the same sick people, and afterwards mixed 
with their fellow-citizens, in every part of the city, without 
changing their clothes. 

The vellow fever appeared early in the season m New- 
Haven, "in Connecticut, and in Providence, on Rhode- 
Island, in both of which places it was derived from putrid 

vol .iv. N 



98 AN ACCOUNT OF THE, &C. 

exhalation, and was speedily and effectually checked by 
removing the healthy persons who lived in its neighbour- 
hood to a distance from it. Several sporadic cases of it 
occurred during the autumn in Gloucester county, in 
New-Jersey, and in Mifflin and Chester counties, in Penn- 
sylvania. It was epidemic in New- York at the same time 
it prevailed in Southwark and Philadelphia. The follow- 
ing extract of a letter from the health officer of New- York, 
to one of his friends contains a satisfactory proof that it 
was not, in that city, an imported disease. 

Quarantine-ground, Sept. 7. 1805. 

I most sincerely and tenderly deplore the unfortunate 
situation of our city. What do people say now of the 
origin of the disease ? You may state for the information 
of those who wished to be informed, that not a single 
vessel, on board of which a person has been sick with fever 
of any kind, or on board of which any person has died 
with any disease, while in the West- Indies, or on the voy- 
age home, has ever gone up to the city during this whole 
season. This we know, and this we vouch for; and 
farther state, that all the cases of fever that have come 
down as from the city, have been all people of, and belong- 
ing to the city, and unconnected with the shipping, ex- 
cepting one, a sailor, who had no connection with any foul 
vessel. There is not a shadow of proof or suspicion that 
can attach to the health-office, or to infected vessels, this 
season. 

I am. &c. 

JOHN R. B. RODGERS. 






AN 



ACCOUNT OF THE DISEASES, 



o* 



1806, 180?, 1809, AND, 180O 



AN ACCOUNT, &c, 



ON the 21st of January in the year 1806, Lieutenant 
NPKeller died of a yellow fever accompanied with a black 
vomiting. A son of Mr. William Flintham in Kej's Valley, 
died of the same disease, and with the same black discharge 
from his stomach on the 5th of May. On the 16th of 
June, there was a partial eclipse of the sun. The mercury 
descended in the thermometer during its continuance, be- 
tween 9°, and 10° in Philadelphia. At Haverhill, in 
Massachusetts it fell from 92° to 62°, in the thermometer. 
In Boston the mercury suddenly mounted to a great height 
in the barometer. During the time of this partial dark- 
ness, fowls and cattle near the city, retired to rest, and all 
the maniacs in the Pennsylvania hospital suddenly became 
silent, but I saw no change induced in the symptoms of 
the diseases of any of the patients who were then under 
my care, by means of this eclipse. In the month of Sep- 
tember the yellow fever prevailed in the Penitential house 
at Richmond in Virginia, where its origin was previously 
traced to domestic putrefaction. 

In the month of March 1807, the influenza appeared at 
the same time in nearly all the States in the Union. It 
prevailed in sporadic cases during the months of April, 
May, June and July, in Philadelphia, but in August it 
became general. It affected children as well as adults, and 
persons ill with other diseases, as well as the healthy. 
Asthma, consumption, madness, parturition, and even a 
salivation afforded no protection from it. Seven old per- 
sons between 80 and 100, and one of 107 died with it. 
The bilious fever which prevailed in August imparted to 
it several of its symptoms. These were obvious remis- 
sions and intermissions, great pain in the back, an apparent 
iiion of the symptoms of the disease on the third, and 
a return of them on the fourth day, cholera morbus, 



102 AN ACCOUNT OF THE DISEASES 

dysentery and an efflorescence upon the skin. The dis. 
ease appeared in one respect to be a monster. Its head, 
and breast wore the characters of influenza, while its trunk 
and limbs indicated it to be a bilious fever. 

It increased gradually until the 20th of August. After 
which time it gradually declined. This was evident not 
only from general observations, but from a list which was 
put into my hands of the number of persons that were bled 
each day of the month, by one of the most popular bleed- 
ers in the city. 

Dr. Dorsey informed me that he had attended two per- 
sons in the yellow fever in the course of this month. 

In February 1808, the measles made their appearance, 
and prevailed during the months of March and April. 
They were at first of a mild character, but afterwards they 
became highly inflammatory, so as to require frequent and 
copious bleedings. 

In the month of August, bowel complaints were unu- 
sually common among adults. They were ascribed in 
part to the use of bread made of flour, which had become 
musty from having remained an unusual time in the mills 
and stores, in consequence of the operation of the embargo 
law. On the 17th of August I attended and cured an 
apprentice of Mr. William M'Corkle who had all the 
common symptoms of a malignant yellow fever. 

The month of September was unusually dry and healthy. 
The healthiness of a great number of the citizens of Phila- 
delphia during this season, was ascribed to their general 
and constant employment in the open air, in all those arts 
and labours which are connected with the building of two 
churches, two shot manufacturies and 600 houses. 

The spring of the year 1809 was unusually cold, so as 
to render vegetation every where in the neighbourhood of 
Philadelphia eighteen days later, than in ordinary years. 
There were a number of cases of sporadic influenza in the 
month of May. On the first and second days of June, 
fires were comfortable. The weather in the two succeeding 
summer months was uncommonly cool. On the 22d flay 
of July, Mr. Richard Durdon the step son of William 
Lewis Esq. died of the yellow fever accompanied withf 
black and bloody discharges upwards and downwards, on 
the fourth day of his disease. Its seeds were derived from 



of 1806, 1807, 1808, 1809. 103 

some putrid fish in a store in Water-street between Walnut 
and Chesnut- streets. Several other persons were affected 
with the yellow fever, or lightly indisposed, from the same 
cause. By removing the putrid fish and cleansing the 
store, the disease ceased in the course of a few weeks. 
From the result of observations upon the degrees of heat in 
Philadelphia, in June and July, between the year 1793 and 
1809, collected and published by Mr. Cadwallader Evans 
in the " True American," of the 2d of August 1809, it 
appears, that the yellow fever has never been epidemic in 
our city when the medium heat of those two summer 
months was below 79° except in 1802 when it was 78°. 
and in which year not more than 200 persons were sup- 
posed to have died of it. The medium heat of June and 
July of the present year, was but 74°. Time alone can 
determine, whether this moderate temperature of the air 
will produce the same general exemption from the disease, 
that it has produced in former years.* There was one 
circumstance which favoured the expectation excited by 
Mr. Evans', observations, of the city escaping an epidemic 
yellow fever, and that was, a chronic, or protracted remit- 
ting fever, of a moderate grade, prevailed during the months 
of July and August in every part of the city and suburbs ; 
from which it was natural to infer, the constitution of the 
atmosphere did not dispose to malignant fevers. 

Upon the subject of the meteorological observations pub- 
lished by Mr. Evans, I shall only add, however generally the 
yellow fever may require a greater degree of medium sum- 
mer heat to produce it than 79° in Philadelphia, it is certain 
fevers from exhalations have often prevailed in other coun- 
tries in a much lower temperature. Dr. Huxham and several 
other physicians describe bilious fevers in open winters, 
and particularly after a sudden thaw has succeeded a great 
froi>t.f 

From a number of observations made through a course 
of many years by an intelligent citizen of Philadelphia, I 
am led to believe that an exemption from the yellow fever 
in our city is intimately connected with the state of the 
winds in March and April. The more they blow from 
the north-west, the dryer they arc, and the more completely 

# Tbis sentence was written about the middle cf August 1809. 
f On air and epidemic diseases, vol. 1. p. 19 



104 AN ACCOUNT OF THE DISEASES, &C. 

they carry off the putrid matters which have been thrown 
upon the surface of the earth by the warmth of the vernal 
sun. Those winds have been called " hungry," from 
their being supposed to devour the matters which they 
convey from our sight. A dry wind in the spring, in a 
certain part of Ireland, has been observed to produce the 
same effect upon the healthiness of the succeeding months. 
Having concluded the history of the bilious yellow fever 
as it has appeared in Philadelphia every year, 1808 only 
excepted, since 1793 as an epidemic, or in sporadic cases, 
I shall proceed next to enumerate all the sources of that 
fever, as well as all the other usual forms of the summer 
and autumnal disease of the United States, and afterwards 
mention the means of preventing them. 



AN INQUIRY 

INTO 

THE VARIOUS SOURCES 

OF THE USUAL FORMS OF 

SUMMER AND AUTUMNAL DISEASE, 
IN THE UNITED STATES, 

AND THE 
MEANS OF PREVENTING THEM. 



VOL. IV. 



AN INQUIRY, &c. 



THE business of the following inquiry is, 

I. to enumerate the various sources of the usual forms 
of the summer and autumnal disease in the United States. 
And, 

II. To mention the means of preventing them. 

To render the application of those means as extensive 
as possible, it will be proper to mention, under the first 
head, all those sources of summer and autumnal disease, 
which have been known to produce it in other countries, 
as well as in the United States. They are, 

1. Exhalations from marshes. These are supposed to 
be partly of a vegetable, and partly of an animal nature. 
They are derived from the shores of creeks and mill ponds, 
as well as from low and wet grounds ; also from the follow- 
ing vegetable substances in a state of putrefaction. 

2. Cabbage. A malignant fever was produced at Ox- 
ford, by a putrid heap of this vegetable some years ago, 
which proved fatal to many of the inhabitants, and to seve- 
ral of the students of the university at that place. 

3. Potatoes. Nearly a whole ship's crew perished at 
Tortola, by removing from her hold, a quantity of putrid 
potatoes. i 

4. Pepper. 

5. Indian meal. 

6. Onions. 

7. Mint. 

8. Anise and caraway seeds, confined in the hold of a 
ship. 

9. Coffee. " About the time," says Dr. Trotter, " when 
notice was taken of the putrefying coffee on the wharf at 
Philadelphia, in the year 1793, a captain of a man of war 



108 ON THE SOURCES OF 

Just returned from the Jamaica station, informed me, that 
several vessels laden with the same produce came to 
Kingston, from St. Domingo. During the distracted state 
of that colony, this article, with other productions, had 
been allowed to spoil and ferment. The evolution of a 
great quantity of fixed air, or carbonic acid gas, was the 
consequence ; and in these vessels, when opening the 
hatchways, such was its concentrated state, that the whole 
of the crew, in some of them, were found dead on the deck. 
A pilot boarded one of them in this condition, and had 
nearly perished himself."* 

10. Chocolate shells. 

11. Cotton which had been wetted on board of a vessel 
that arrived in New- York, a few years ago, from Savannah, 
in Georgia. 

12. Hemp, flax, and straw. 

13. The canvas of an old tent. 

14. Old books, and old paper money, that had been 
wetted, and confined in close rooms and closets. 

15. The timber of an old house. A fever produced by 
this cause is mentioned by Dr. Haller, in his Bibliotheca 
Medicinse. 

16. Green wood confined in a close cellar during the 
summer months. A fever from this cause was once pro- 
duced in this city, in a family that was attended by the 
late Dr. Cadwallader. 

17. The green timber of a new ship. Captain Thomas 
Bell informed me, that in a voyage to the East- Indies, in 
the year 1784, he lost six of his men with the scurvy, 
which he supposed to be derived wholly from the foul air 
emitted by the green timber of his ship. The hammocks 
which were near the sides of the ship rotted during the 
voyage, while those which were suspended in the middle 
of the ship, retained their sound and natural state. This 
scurvy has been lately proved by Dr. Claiborne, in an 
ingenious inaugural dissertation, published in Philadelphia, 
in the year 1798, to be a misplaced state of malignant 
fever. Dr. Lind mentions likewise the timber of new 
ships as one of the sources of febrile diseases. The tim- 
ber of soldiers' huts, and of the cabins of men who follow 
the business of making charcoal in the woods, often pro- 

* Medicina Nautica. p. 324. 






SUMMER AND AUTUMNAL DISEASE. 109 

duce fevers, as soon as the bark begins to rot and fall from 
them, which is generally on the second year after they are 
erected. Fevers have been excited even by the exhalation 
from trees, that have been killed by being girdled in an old 
field. 

18. The stagnating air of the hold of a ship. 

19. Bilge water. 

20. Water that had long been confined in hogsheads at 
sea. 

21. Stagnating rain water. 

22. The stagnating air of close cellars. 

23. The matters which usually stagnate in the gutters, 
common sewers, docks, and alleys of cities, and in the 
sinks of kitchens. A citizen of Philadelphia, who had a 
sink in his kitchen, lost a number of cats and dogs by 
convulsions. At length one of his servants was affected 
with the same disease. This led him to investigate the 
cause of it. He soon traced it to his sink. By altering 
its construction, so as to prevent the escape of noxious air 
from it, he destroyed its unwholesome quality, so that all 
his domestics lived ji good health in his kitchen afterwards. 

24 Air emitted by agitating foul and stagnating water. 
Dr. Franklin was once infected with an intermitting fever 
from this cause. 

25. A duck pond. The children of a family in this 
city were observed, for several successive years, to be 
affected with a bilious remitting fever. The physician of 
the family, Dr. Phineas Bond, observing no other persons 
to be affected with the same fever in the neighbourhood, 
suspected that it arose from some local cause. He exam- 
ined the yard belonging to the house, where he found an 
offensive duck pond. The pond was filled with earth, and 
the family were afterwards free from an annual bilious 
fever. 

26. A hog-stye has been known to produce violent 
bilious fevers throughout a whole neighbourhood in 
Philadelphia. 

27. Weeds cut down and exposed to heat and moisture 
near a house. 

Fevers are less frequently produced by putrid animal, 
than by putrid vegetable matters. There are, however 



110 ON THE SOURCES OF 

instances of their having been generated by the following 
animal substances in a state of putrefaction. 

1. Human bodies that have been left unburied upon a 
field of battle. 

2. Salted beef and pork. 

3. Locusts. 

4. Raw hides confined in stores, and in the holds of 
ships. 

5. A whale thrown upon the sea shore in Holland. 

6. A large bed of oysters. The malignant fevers which 
prevailed in Alexandria, in Virginia, in 1803, and in South- 
wark, adjoining Philadelphia, in the year 1805, were de- 
rived from this cause * 

7. The entrails of fish. And, 

8. Privies. The diarrhoea and dysentery are produced, 
oftener than any other form of summer and autumnal dis- 
ease, by the foetor of privies. During the revolutionary 
war, an American regiment, consisting of 600 men, were 
affected with a dysentery, from being encamped near a 
large mass of human faeces. The disease was suddenly 
checked by removing their encampment to a distance from 
it. Five persons in one family were affected with the yel- 
low fever in Philadelphia, in 1805, who lived in a house in 
which a privy in the cellar emitted a most offensive smell. 
No one of them had been exposed to the foul air of South- 
wark, in which the fever chiefly prevailed in the Autumn 
of that year. Three of them sickened at the same time, 
which obviated the suspicion of the disease being produced 
by contagion. 

The miasmata which are exhaled from putrid vegetable 
and animal matters, are much varied by circumstances, in 
their effects upon the body. Certain vegetables, particu- 
larly coffee, potatoes, and hemp, in a state of putrefaction, 
exhale a more noxious gas than any other vegetables, and 
putrid salted meat and fish, are more disposed to produce 
malignant fevers than meat and fish that are fresh, and both 
are more destructive when they exhale their miasmata from 

* It has been a common practice with many families, in New-York and 
Philadelphia, for several years past, to lay in a winter store of oysters in 
their cellars in the fall of the year. May not a part of these oysters, left 
in these cellars from forgetfulness, or from being unfit for use, b come, by 
putrefying there, the cause of malignant fevers in the succeeding summer 
and autumn ? 



SUMMER AND AUTUMNAL DISEASE. Ill 

places which have been confined, than in the open air. 
This is one reason why the yellow fever generally makes 
its first appearance and is attended with most mortality 
near the wharves and water streets of sea port towns, the 
miasmata in such places being emitted from putrid animal 
and vegetable matters, which had been confined in stores, 
cellars and the holds of ships. 

There are several other sources of malignant fevers be- 
sides those which have been mentioned. They are, exha- 
lations from volcanoes, wells, and springs of water ; also 
flesh,* fish, and vegetables, eaten in a putrid state ; but 
these seldom act in any country, and two of them only, 
and that rarely, in the United States. 

It has been said that we sometimes meet with bilious 
fevers in situations where no exhalations had taken place 
from any of the sources that have been enumerated. Dr. 
Gordon informed me that 500 persons died of the yellow 
fever in Berbice between July 1804 and May 1805, during 
which time there fell not quite three inches of rain. The 
earth in this case was every where dry and parched. Bil- 
ious fevers, Sir John Pringle tells us occur in. a part of 
Holland in very dry seasons, but in these cases the earth 
cracks, and putrid exhalations escape from water which 
stagnates below its surface. The same cause which pro- 
duced these fevers in Holland, probably induced the fever 
at Berbice, mentioned by Dr. Gordon, as also all such 
bilious fevers as appear under the same circumstances of the 
apparent absence of moisture and putrefaction. 

The usual forms of the disease produced by miasmata 
from the sources of them which have been enumerated 
are, 

1. Malignant or bilious yellow fever. 

2. Inflammatory bilious fever. 

3. Mild remittent. 

* The following fact, communicated to me by Mr. Samuel Lyman, a 
meml>er of congress from the state of Massachusetts, shows the importance 
of attending to the condition of butchers' meat in our attempts to prevent 
malignant fevers. 

A farmer in New-Hampshire, who had overheated a fat ox by excessive 
labour in the time of harvest, perceiving him to be indisposed, instantly 
killed him, and sent his flesh t<> a neighbouring market. Of twenty-four 
persons who ate of tiiis flesh, fifteen died in a few days. The fatal dis- 
use produced by this aliment fell, with its chief force, upon the stomach 
ftnd bowels. 



112 ON THE MEANS OP PREVENTING 

4. Mild intermittent. 

5. Chronic, or what is called nervous fever, or the au- 
tumnal fever in a protracted form. 

6. Febricula. 

7. Dysentery. 

8. Colic. 

9. Cholera morbus. 

10. Diarrhoea. 

In deriving all the above forms of disease from mias- 
mata, I do not mean to insinuate, that sporadic cases of 
each of them are not produced by other causes. 

In designating them by a single name, I commit no 
breach upon the ancient nomenclature of medicine. The 
gout affects not only the blood-vessels and bowels,, but 
every other part of the body, and yet no writer has, upon 
that account, distinguished it by a plural epithet. 

The four last forms of disease, that have been mention- 
ed, have been very properly called intestinal states of fever. 
They nearly accord, in their greater or less degrees of 
violence and danger, with the first four states of fever 
which occupy the blood-vessels, and in the order in which 
both of them have been named. I shall illustrate this re- 
mark by barely mentioning the resemblance of the yellow 
fever to the dysentery, in being attended with costiveness 
in its first stage, from a suspended or defective secretion 
or excretion of bile, and in terminating very generally in 
death, when not met by the early use of depleting re- 
medies. 

The variety in the forms and grades of the summer and 
autumnal disease, in different seasons, and their occasional 
changes into each other in the same seasons, are to be 
sought for in the variety of the sensible and insensible 
qualities of the atmosphere, of the course of the winds, and 
of the aliments of different years. 

11. The means of preventing the different forms of dis- 
ease that have been mentioned, come next under our con- 
sideration. 

Happily for mankind, Heaven has kindly sent certain 
premonitory signs of the most fatal of them. These signs 
appear, 

I. Externally, in certain changes in previous diseases, 
in the atmosphere, and in the animal and vegetable creation. 



SUMMER AND AUTUMNAL DISEASE. 113 

II. In the human body. 

1. The first external premonitory sign that I shall men- 
tion is, an unusual degree of violence in the diseases of 
the previous year or season. Many proofs of the truth of 
this remark are to be met with in the works of Dr. Syden- 
ham. It has been confirmed in Philadelphia, in nearly all 
her malignant fevers since the year 1793. It would seem 
as if great and mortal epidemics, like the planets, had 
satellites revolving round them, for they are not only pre- 
ceded, but accompanied and followed, by diseases which 
appear to reflect back upon them some of their malignity. 
But there is an exception to this remark, for we now and 
then observe uncommon and general healthiness, before the 
appearance of a malignant epidemic. This was the case 
in Philadelphia, previously to the fevers of 1798 and 1799. 
I have ascribed this to the stimulus of the pestilential mi- 
asmata barely overcoming the action of weak diseases, 
without being powerful enough to excite a malignant 
fever. 

2. Substances, painted with white lead, and exposed to 
the air, suddenly assuming a dark colour ; and winds from 
unusual quarters, and unusual and long protracted calms, 
indicate the approach of a pestilential disease. The south 
winds have blown upon the city of Philadelphia, ever since 
1793, more constantly than in former years. A smokiness 
or mist in the air, the late Or. Matthew Wilson has re- 
marked, generally precedes a sickly autumn in the state of 
Delaware. 

3. Malignant and mortal epidemics are often preceded 
by uncommon sickness and mortality among certain birds 
and beasts.' They have both appeared, chiefly among 
wild pigeons and cats in the United States. The mor- 
tality among cats, previous to the appearance of epidemics, 
has been taken notice of in other countries. Dr. Willan 
says it occurred in the city of London, between the 20th 
of March and the 20th of April, in the year 1797, before 
a sickly season, and Dr. Buneiva says it preceded a mortal 
epidemic in Paris. The cats, the Doctor remarks, lose, 
on the second day of their disease, the power of emitting 
electrical sparks from their backs, and, when thrown from 
a height, do not, as in health, fall upon tiieir feet.* 

* Medical Journal, Vol. iv. 
VOL. IV. F 



114 ON THE MEANS OP PREVENTING 

4. The common house fly has nearly disappeared from 
our cities, moschetoes have been multiplied, and several 
new insects have appeared, just before the prevalence of 
our late malignant epidemics. 

5. Certain trees have emitted an unusual smell ; the 
leaves of others have fallen prematurely ; summer fruits 
have been less in size, and of an inferior quality ; and 
apples and pears have been knotty, in the summers pre- 
vious to several of our malignant autumnal levers. Dr. Am- 
brose Parey says, an unusually rapid growth of mushrooms 
once preceded the plague in Paris. 

II. The premonitory signs of an approaching malignant 
epidemic in the human body are, 

1. A sudden drying up, or breaking out of an old sore; 
fresh eruptions in different parts of the body ; a cessation 
of a chronic disease, or a conversion of a periodical into a 
continual disease. Of this there were many instances in 
Philadelphia, in the year 1793. 

2. A peculiar sallowness of the complexion. This was 
observed to be general in Philadelphia, previous to the 
yellow lever of 1793. Dr. Dick informed me, that he had 
observed the same appearance in the faces of the people of 
Alexandria, accompanied in some cases with a yellowness 
of the eyes, during the sumner of 1793, and previous to 
the appearance of a violent bilious fever on the banks of 
the Potowmac. 

3. I have observed one or more of the following symp- 
toms, namely, head-ach ; a decay, or increase of appetite; 
cobiiveness ; a diminished or increased secretion of urine ; 
a hot and offensive breath ;* constant sweats, and some- 
times of a foetid nature, or a dry skin ; wakefulness, or a 

* I have once known this breath, in a gentleman who had carried the 
seeds of the yellow fever in his body from Philadelphia into its neighbour- 
hood, create sickness :it the stomach in his wife , and I have heard of an 
instance in which a pers •-.», who left Philadelphia when highly impregnat- 
ed with the miasmata of the same fever, creating sickness ai the stomach 
in four or five persons who sat at the same table with him in the country. 
N< ne of the above persons were afterwards affected by the fever. In an 
anonymous history of the plague in London, in the year 1664, in the posses- 
sion of the author, it is said, thebrea'h was a well-known signal of infec- 
tion to persons who were not infected, and that whenever it was perceived, 
individuals and companh s fled from it. The sickness in the above-men- 
tioned persons was similar to that which is sometimes excited by the smell 
of a sore leg, or a gun-shot wound, upon the removal of its first dressing. 
It does not produce fever, because there is no predisposition to it. 



SUMMER AND AUTUMNAL DISEASE. 115 

disposition to early or protracted sleep ; a preternaturally 
frequent pulse ; unusual vivacity, or depression of spirits ; 
fatigue and sweats from light exertions ; hands, when rub- 
bed, emitting a smell like hep^r sulphuris ; and, lastly, a 
sense of burning in the mouth ; to be present in different 
persons, during the prevalence of our malignant epidemics. 
The means of preventing the different forms of our sum- 
mer and autumnal disease comes next under our considera- 
tion. I shall first mention such as have been most effectual in 
guarding against its malignant form, and afterwards take 
notice of such as are proper in its milder grades. These 
means naturally divide themselves again, 

I. Into such as are proper to protect individuals. 

II. Such as are proper to defend whole communities 
from the disease. And, 

III. Such as are proper to exterminate it, by removing 
its causes. 

I. Of the means of protecting individuals. 

Where flight is practicable, it should be resorted to in 
every case, to avoid an attack of a malignant fever. The 
heights of Germantown and Darby have, for many years, 
afforded a secure retreat to a large number of the citizens 
of Philadelphia, from their late annual epidemics. It were 
to be wisiied our governments possessed a power of com- 
pelling our citizens to desert the whole, or parts, of infect- 
ed cities and villages. In this way the yellow fever was 
suddenly annihilated in Providence, on Rhode- Island, and 
in New-Haven, in Connecticut, in the year 1805. But 
the same power should rigorously prevent the removal of 
the sick, except it be that class of them which have neither 
homes nor friends. The less the distance they are carried 
beyond the infected atmosphere, the better. The injury 
sustained by conveying them in a jolting carriage, for two 
or three miles, has often been proclaimed in the reports of 
our city hospitals, of patients being admitted without a 
pulse, and dying a few hours afterwards. 

In leaving a place infected by miasmata, care should be 
taken not to expose the body to great cold, heat, or fatigue, 
for eighteen or twenty days, lest they should excite the 
dormant seeds of the disease into action. 

But where a flight is not enforced by law, or where it is 
not practicable, or preferred, safety should be sought for 



116 OF THE MEANS OF PREVENTING 

in such means as reduce the preternatural tone and fulness 
induced in the blood-vessels by the stimulus of the miasmata, 
and he suppression of customary secretions. — These are, 
1. A diet, accommodated to the greater or less exposure 
of the body to the action of miasmata, and to the greater 
or less degrees of labour, or exercise, which are taken. In 
cases of great exposure to an infected atmosphere, with 
but little exercise, the diet should be simple in its quality, 
and small in its quantity. Fresh meats and wine should 
be avoided. A little salted meat, and Cayenne pepper with 
vegetables, prevent an undue languor of the stomach, from 
the want of its usual cordial aliments. The less mortality 
of the yellow fever in the French and Spanish West- India 
islands than in the British, has been justly attributed to the 
more temperate habits of the natives of France and Spain. 
The Bramins, who live wholly upon vegetables, escape the 
malignant fevers of India, while whole regiments of Euro- 
peans, who eat animal food, die in their neighbourhood. 
The people of Minorca, Dr. Cleghorn says, who reside 
near gardens, and live chiefly upon fruit during the sum- 
mer, escape the violent autumnal fever of that island. The 
Jews in Surinam, Dr. Nassy tells us in his history of that 
settlement, escape bilious fevers, by eating fruit at 12 
o' lock, and using fish oil, and a considerable quantity of 
spices, particularly pepper in their aliment, while the chris- 
tians who eat and drink agreeably to their European habits, 
perish in great numbers by those diseases. The field 
negroes of South-Carolina owe their exemption from 
bilious fevers to their living chiefly upon vegetables. There 
is a fact which shows, that not only temperance, but ab- 
stinence bordering upon famine, has afforded a protection 
from malignant fevers. In a letter which I received a few 
months ago, from the Rev. Thomas Hall, chaplain to the 
British factory at Leghorn, containing an account of the 
yellow fever which prevailed in that city, in the summer 
and autumn of 1804, there is the following communication. 
" Of the rich, who live in airy houses, there died but four 
persons with the fever. Of the commodious, who live 
comfortably, but not affluently, there died ten. Of the 
poor, who inhabited small and crowded rooms, in the 
dirty and confined parts of the, city, there died nearly seven 
hundred. But of the beggars, who had scarcely any thing 



SUMMER AND AUTUMNAL DISEASE. 117 

to eat, and who slept half naked every night upon hard 
pavements, not one died." From the reduced and ex- 
hausted state of the system in these people they were inca- 
pable, if I may be allowed the expression, of the combus- 
tion of fever. Persons reduced by chronic diseases, in like 
manner, often escape such as are acute. Six French ships 
of the line landed three hundred sick, at St. Domingo, 
while the yellow fever prevailed there in the year 1745, 
and yet no one of them was infected by it.* 

Where the body is exposed to miasmata, and a great 
deal of exercise taken at the same time, broth, a little wine, 
or malt liquors, may be used with the fruits and garden 
vegetables of the season, with safety and advantage. The 
change from a full to a low diet should be made gra- 
dually. When made suddenly, it predisposes to an attack 
of the disease. 

2. Laxative medicines. Hundreds, perhaps thousands, 
of the citizens of Philadelphia were indebted for their pre- 
servation from the yellow fever, to the occasional use of a 
calomel pill, a few grains of rheubarb, or a table spoonful 
of sweet, or castor oil, during the prevalence of our late 
pestilential fevers. Even the air of Batavia has been de- 
prived of its poisonous quality, by means of this class of 
medicines. A citizen of Philadelphia asked a captain of a 
New- England ship, whom, he met at that island, how he 
preserved the whole crew of his ship in health, while half 
the sailors of all the other ships in the harbour were sick or 
dead. He informed him, that it was by giving each of 
them a gentle purge of sulphur every day. 

3. A plentiful perspiration, or moderate sweats, kept up 
by means of warm clothing and bed clothes. The excretion 
which takes place by die skin, is a discharge of the first 
necessity. I have never known an instance of a person's 
being attacked by the yellow fever in whom this discharge 
was constant, and equally diffused all over the body. Its 
effects are equally salutary in preventing the plague. So 
well known is this fact, that Mr. Volney informs us in his 
Travels into Egypt, that the common salutation at Cairo, 
during the prevalence of the plague, is, " Do you sweat 
freely ?" For the purpose of promoting this excretion, 
flannel shirts or waistcoats worn next to the skin have been 

* Desportes, vol. i. p, 140. 



118 ON THE MEANS OF PREVENTING 

found more useful than linen. As the perspiration and 
sweats, which are thus discharged in a Pestilential season, 
are often unusual in their quantity, and of a morbid quality, 
clean body- linen or flannel should be put on every day, 
and where this is not practicable, that which has been 
worn should be exchanged every morning and evening 
for that which has been exposed during the previous day 
and night, in a dry air. 

4. Blood-letting. In addition to the authorities of Dr. 
Haller and Dr. Hodges, mentioned in another place,* in 
favour of this remedy, I shall subjoin a few others. Dr. 
Mitchell, in his Account of the Yellow Fever which pre- 
vailed in Virginia, in the year 1741, informs us, that it 
was often prevented in persons who were under the influ- 
ence of its remote cause, by the loss of a few ounces of 
blood. It was formerly a practice among the Physicians 
in St. Domingo, to bleed whole regiments of troops as 
soon as they arrived from France, by which means they 
were preserved from the malignant fever of the island. 

During the short visit paid to this city, in the year 1798, 
by Dr. Boland, a respectable physician of the British army, 
he put into my hands the following communication. " In 
the beginning of the August, 1797, 109 Dutch artillery 
arrived at Port au Prince, in the Bangalore transport. The 
florid appearance of the men, their cumbersome clothing, 
and the season of the year, seemed all unfavourable omens 
of the melancholy fate we presumed awaited them. It was, 
however, thought a favourable opportunity, by Dr. Jack- 
son and myself, to try what could be done in warding off 
the fever. It was accordingly suggested to Monsieur 
Couturier, the chief surgeon of the foreign troops, and the 
surgeon of the regiment, that the whole detachment should 
be blooded freely, and that, the morning after, a dose of 
physic should be administered to every man. This was 
implicitly complied with, a day or two after, and at this 
moment in wnich I write, although a period of four 
months has elapsed, but two of that detachment have died, 
one of whom was in a dangerous state when he landed. 
A suceess unparalleled during the war in St. Domingo ! 
It is true, several have been a tacked with the disease, but 
* Account of the Yellow Fever in 1793., Vol. III. 



SUMMER AND AUTUMNAL DISEASE. 119 

in those the symptoms were less violent, and readily sub- 
sided by the use ol* the lancet. 

" The crew of the Bangalore, on her arrival at Port au 
Prince, consisted of twenty-eight men. With them no 
preventative plan was followed. In a very few weeks, 
eight died, and at present, of the original number, but 
fourteen remain." 

All these depleting remedies, whether used separately or 
together, induce sueh an artificial debility in the system, 
as disposes it to vibrate more readily under the impression 
of the miasmata. Thus the willow rises, after bowing 
before a blast of wind, while the unyielding oak falls to 
the ground by its side. It is from 'the similarity of the 
natural weakness in the systems of women, in the West- 
Indies, with that which has been induced by the artificial 
means that have been mentioned, that they so generally 
escape the malignant endemic of the islands. 

A second class of preventatives of malignant fever are 
such as obviate the internal action of miasmata, by exciting 
a general or partial determination to the external surface of 
the body. These are, 

1. The warm bath. I have known this grateful remedy 
used with success in our city. It serves the treble purposes 
of keeping the skin clean, and the pores open, and of de- 
fending what are called the vital organs from disease, by 
inviting its remote cause to the external surface of the 
body. 

2. The cold bath, or cold water applied to the external 
surface of the body. Ulloa, in his travels through Cuba, 
tells us the Spaniards make it a practice, when partially 
wetted by rain, to plunge themselves, with their wet 
clothes on, into the first stream of water they meet with 
afterwards, by which means they avoid taking the fever of 
the island. When this cannot be conveniently done, the 
peasants strip off their clothes, and put them under a shelter, 
and receive showers of rain upon their naked bodies, and 
thus preserve themselves from the fever. Dr. Baynard 
has left it upon record, in his treatise upon the cold bath, 
that those persons who lived in water-mills, also watermen, 
bargemen, and fishermen, who were employed upon the 
river, and in dabbling in cold water, were rarely affected 
by the plague in London in 1665, and that but two persons 



120 ON THE MEANS OF PREVENTING 

died with it on London bridge. The water carriers at 
Cairo, Mr. Volney says, uniformly escape the plague ; 
and, Dr. Chisholm informs us, that those negroes in De- 
marara who go naked, and are thereby disposed not to 
avoid showers of rain, are never affected with the fever of 
that country. 

3. Washing the body every morning and evening with 
salt water. A whole ship's crew from Philadelphia was 
preserved by this means from the yellow fever, some 
years ago, in one of the West-India islands, while a large 
proportion of the crews of several ships, that lay in the 
same harbour perished by that disease. 

4. Anointing the body with oil. The natives of Africa, 
and some American Indians, use this preventative with 
success during their sickly seasons. It has lately been 
used, it is said, with effect in preventing the plague. Its 
efficacy for that purpose was first suggested by no oilman 
having died of that disease during four years, in which 
time 100.000 people perished with it in Egypt. Oliver, in 
his travels into that country, says, the men who make and 
sell butter, are equally fortunate i:i escaping it. 

5. Issues, setons, and blisters belong to this class of 
preventatives of malignant and bilious fevers. 

Issues, according to Parisinus, Florentinus, and several 
other authors quoted by Diemerbroeck, have prevented 
the plague in many hundred instances. Parcaeus says, all 
who had ulcers from the venereal disease, or any other 
cause, escaped it. Dr. Hodges owed his preservation from 
the plague in London, in 1665, to an issue in his leg. He 
says he always felt a slight pain in it when he went into a 
sick room. Dr. Gallaher ascribed his escape from the 
yellow fever of 1799 to a perpetual blister, which he ap- 
plied to his arm for that purpose. Dr. Barton favoured 
me with a sight of a letter from Dr. James Stevens, dated 
January 12th, 1801, in which he says he believed Dr. 
Beach (formerly of Connecticut,) had been preserved from 
the bilious fever by a seton in his side. He adds further, 
that Dr. Beach had been called to attend the labourers at 
Onandogo salt springs, in the State of New- York, ninety- 
eight of whom out of a hundred had the bilious fever. Of 
the two who escaped it, one had a sore leg, the other what 
is called a scald head. The discharge from the sores in 



SUMMER AND AUTUMNAL DISEASE. 121 

each of them, as well as from the doctor's issue, was 
more copious during the prevalence of the fever, than it 
had been at any other time. 

A third class of preventatives of malignant fever, are 
such as excite a general action, more powerful than that 
which the miasmata are disposed to create in the system, 
or an action of a contrary nature, these are, 

1. Onions and garlic. All those citizens who used 
these vegetables in their diet, escaped the yellow fever in 
1793. The greater exemption of the natives of France 
from this disease, wherever they are exposed to it, than 
of the inhabitants of other European countries, has been 
ascribed in part to the liberal use of those condiments in 
their food. The Jews, it has been said, have often owed 
to them their preservation from the plagues which for- 
merly prevailed in Europe. It is probable leeks and 
onions, which to this day form a material part of the diet 
of the inhabitants of Egypt, w.ere cultivated and eaten 
originally as the means of obviating the plagues of that 
country. I have been at a loss to know why the Auihor 
of Nature, who has endowed these vegetables with so 
many excellent qualities for diet and medicine, should 
have accompanied them with such a disagreeable smell. 
Perhaps the reason was, kindly to force them into uni- 
versal use ; for it is remarkable their smell in the breath 
is imperceptible to those who use them. 

2. Calomel, taken in such small doses as gently to 
affect the gums. It preserved most of the crew of a 
Russian ship at Plymouth, in the year 1777, from a fever 
generated by filth in her hold. In a letter which I receiv- 
ed from Captain Thomas Truxton, in the year 1797, 
he informed me, that an old and respectable merchant at 
Batavia had assured him, he had been preserved in good 
health by calomel, taken in the way that has been men- 
tioned, during the sickly seasons, for upwards of thirty 
years. The mortality of the fevers of that island may easily 
be conceived of, when I add, on the authority of a physi- 
cian quoted in Sir George Staunton's Account of his 
Embassy to China, that one half of all new comers die 
there on the first year of their arrival. 

vol. iv. <i 



122 ON THE MEANS OF PREVENTING 

Our principal dependence should be placed upon those 
two preventives under this head. There are several others 
which have been in common use, some of which I be- 
lieve are hurtful, and the rest are of feeble, or doubtful 
efficacy. They are, 

3. Wine and ardent spirits. They both prevent a 
malignant fever, only when they excite an action in the 
system above that which is ordinarily excited by the mias- 
mata of the fever ; but this cannot be done without pro- 
ducing intoxication, which, to be effectual, must be per- 
petual ; for the weakness and excitability, which take 
place in the intervals of drunkenness, predispose to the 
disease. Agreeably to this remark, I obstrvtd three 
persons, who were constantly drunk, survive two of our 
most fatal epidemics, while all those persons who were 
alternately drunk and sober, rarely escaped an attack of 
the fever. In most of them it terminated in death. 

4. Tobacco. Many hundreds of the citizens of Phi- 
ladelphia can witness, that no benefit was derived from 
this weed, in any of the ways in which it is commonly 
used, in the late epidemics of our city. Mr. Howard 
says it has no effect in preserving from the plague. 

5. Camphor suspended in a bag round the neck, and 
rags wetted in vinegar, and applied to the nose. These 
means were in general use in the fever of 1793, in Phi- 
ladelphia, but they afforded no protection from it. It is 
possible they had a contrary effect, by entangling in their 
volatile particles, more of the miasmata of the fever, and 
thus increasing a predisposition to it. 

A fourth class of preventives of malignant fevers are 
certain substances which are said to destroy miasmata 
by entering into mixture with them. Two persons, who 
were very much exposed to the causes of the fever in 
1798, took each of them a table spoonful of sweet oil 
every morning. They both escaped the fever. Did the 
oil, in these cases, act by destroying miasmata in the 
stomach chemically ? or did it defend the stomach me- 
chanically from their action ? or did it prevent the disease, 
only by gently opening the bowels ? It is certain the fat 
of pork meat protects the men who work in the lead 
mines of Great-Britain from the deleterious effects which 



SUMMER AND AUTUMNAL DISEASE. 123 

the fumes of that metal are apt to bring upon the stomach 
and bowels, and that a poisoned arrow, discharged into 
the side of a hog, will not injure him, if it be arrested 
by the fat which lines that part of his body. 

The vapours which issue from fresh earth has been 
supposed to destroy the miasmata which produce malig- 
nant fevers, by entering into mixture with them. Most 
of the men who were employed in digging graves and 
cellars, and in removing the dirt from the streets of Phi- 
ladelphia, in 1793, escaped the fever of that year. In 
the new settlements of our country, it is said, the poison 
of the rattle snake is deprived of its deadly effects upon 
the body, by thrusting the wounded limb into a hole 
recently made in the earth. The fable of Anteus who 
rose with renewed strength from the ground after repeated 
falls, was probably intended to signify, among other 
things, the salutary virtues which are contained in the 
effluvia which issue from fresh clods of earth. 

3. There are many facts which show the efficacy of 
the volatile alkali in destroying, by mixture, the poison 
of snakes. One of them was lately communicated to 
the public by Dr. Ramsay, of South- Carolina. What 
would be the effect of the daily use of a few tea-spoon- 
fuls of this medicine in a liquid form, and of frequently 
washing the body with it, during the prevalence of pesti- 
lential epidemics ? 

The miasmata which produce malignant fevers often 
exist in an offensive state in the body, for weeks and 
perhaps months, without doing any harm. With but a 
few exceptions, they seldom induce a disease without 
the reinforcement of an exciting cause. In vain, there- 
fore, shall we use all the preventives that have been re- 
commended, without, 

V. Avoiding of all its exciting causes. These are, 

1. Heat and cold. While the former has excited the 
yellow fever in thousands, the latter has excited it in tens 
of thousands. It is not in middle latitudes only that 
cold awakens this disease in the body. Dr. Mosely 
says it is a more frequent exciting cause of that, and of 
other diseases, in the island of Jamaica, than in any of the 
most temperate climates of the globe. It is this which 



124 ON THE MEANS OF PREVENTING 

renders cases of yellow fever, when epidemic in our 
cities, more numerous in the cool months of September 
and October, than in July and August. For the purpose 
of avoiding this pernicious and universal influence of cold, 
the clothing and bed-covers should be rather warmer in 
those months, in middle and northern latitudes, than is 
agreeable, and fires should be made every morning and 
evening in common sitting rooms, and during the whole 
day, when the weather is damp or cool. They serve not 
only to prevent the reduction of the excitement of the 
blood-vessels, by the gradual and imperceptible abstrac- 
tion of the heat of the body, but to convey up a chim- 
ney all the unwholesome air that accumulates in those 
rooms during a sickly season. By these precautions, I 
have known whole lamilies preserved in health, while 
all the neighbours who neglected them, have been confi. 
ned by a prevailing autumnal fever. 

3. The early morning and evening air, even in warm 
weather. 

4. Fatigue from amusements, such as fishing, gun- 
ning, and dancing, and from unusual labour or exercise. 
The effects of fatigue from this cause have been already 
noticed,* in the maids of large families being the only 
persons who die of the fever, in consequence of their 
having performed great and unusual services to those 
branches of the family who survive them, while nurses, 
who only exercise their ordinary habits in attending sick 
people, are seldom carried off by it. 

5. Intemperance in eating and drinking. 

6. Partaking of new aliments and drinks. The sto- 
mach, during the prevalence of malignant fevers, is al- 
ways in an irritable state, and constantly disposed to be 
afFected by impressions that are not habitual to it. 

7. Violent emotions or passions of the mind. 

8. The entire cessation of moderate labour. This, by 
permitting the mind to ramble upon subjects of terror 
and distress, and by exposing the body to idleness and 
company, favours an attack of fever. A predisposition 
to it, is likewise created by alternating labour and idle- 
ness, with each other. 

* Account of the Yellow Fever in 1793, vol. Hi 



SUMMER AND AUTUMNAL DISEASE. 125 

9. The continuance of hard labour. The miasmata 
which produce malignant fevers sometimes possess so 
mud i lorce, that the least addition to it, even from cus- 
tomary acts of labour, is sufficient to excite the disease. 
In this case, safety should be sought in retirement, more 
especially by those persons whose occupations expose 
them to the heat of fires, and the rays of the sun, such 
as hatters, smiths, bricklayers, and house and ship car- 
penters. The wealthy inhabitants of Constantinople and 
Smyrna, erroneously suppose they escape the contagion 
of the plague, by shutting themselves up in their houses 
during its prevalence. They owe their preservation 
chiefly to their being removed, by an exemption from care 
and business, from all its exciting causes. Most of the 
nobility and gentry of Moscow, by these means escaped 
a plague which carried off* 27,000 persons in that city, 
in the year 1771, and many whole families in Philadel- 
phia were indebted for their safety to the same precau- 
tions in the year 1793. Confinement is more certain in 
its beneficial effects, when persons occupy the upper 
stories only of their houses. The inhabitants of St. 
Lucia, Dr. Chisholm says, by this means often escape 
the yellow fever of that island. Such is the difference 
between the healthiness of the upper and lower stories 
of a house, that travellers tell us, birds live in the for- 
mer, and die in the latter, during the prevalence of a 
plague in the eastern countries. But the benefits of con- 
finement and rest, are by no means general in preserving 
persons from the plague and yellow fever. Some late 
accounts from Egypt, teach us that an atmosphere infec- 
ted with putrid miasmata sometimes penetrates into the 
retreats of the wealthy and the timid, and spreads with its 
usual mortality among them. Solitary instances of the 
same thing have occurred in Philadelphia, in families 
which have lived in retirement during the prevalence of 
the yellow fever. 

All the exciting causes that have been enumerated 
should be avoided with double care three days before, 
and three days after, as well as on the days of the full 
and change of the moon. The reason for this caution 



126 ON THE MEANS OF PREVENTING 

was given in the account of the yellow fever in Phila- 
delphia in the year 1797. 

To persons who had retired from infected cities, or 
countries, it will be necessary to suggest a caution, not 
to visit them while the malignant fever from which they 
fled prevails in them. Dr. Dow informed me, in his 
visit to Philadelphia in the year 1800, that the natives 
and old citizens of New-Orleans who retired into the 
country, and returned during the prevalence of the yel- 
low fever in that city, the year before, were often affec- 
ted by it, while all such persons as did not change their re- 
sidence, escaped it. The danger from visiting an infected 
city is greater to persons who breathe an atmosphere of a 
uniform temperature, than one that is subject to alternate 
changes in its degrees of heat and cold. The inhabi- 
tants of Mexico, Baron Humboldt informed me, who 
descend from their elevated situation, where the ther- 
mometer seldom varies more than ten degrees in the 
year, and visit Vera Cruz during the prevalence of the 
yellow fever in that city, are much oftener affected by it 
than the new comers from the variable climates of Euro- 
pean countries. But the habits of insensibility to the 
impressions of the miasmata of this disease in one coun- 
try, do not always protect the system from their action in 
another. The same illustrious traveller informed me, 
that the inhabitants of the Havannah who visit Vera 
Cruz, and the inhabitants of Vera Cruz who visit the 
Havannah, are affected in common with strangers with 
the fever of those places. 

I shall take leave of this part of our subject, by ad- 
ding, that I am so much impressed with a belief in the 
general, and almost necessary connection of an exciting 
cause with a yellow fever, that were I to enter a city, 
and meet its inhabitants under the first impressions of 
terror and distress from its appearance, "my advice to 
them should be, " Beware," not of contagion, for the 
yellow fever of our country is not contagious, nor of pu- 
trid exhalations, where the duties of humanity or con- 
sanguinity require your attendance, but "beware of 

EXCITING CAUSES I" 



SUMMER AND AUTUMNAL DISEASE. 127 

In the mild grades of the summer and autumnal fevers 
of the United States, the means of prevention should be 
different from those which have been recommended to 
prevent the yellow fever. They consist of such things 
as gently invigorate the system, and thus create an action 
superior to that which the miasmata have excited in it. 
The means commonly employed for this purpose are, 

1. Cordial diet and drinks ; consisting of salted meat, 
and fish, with a moderate quantity of wine and malt 
liquors. Dr. Blane says, the British soldiers who lived 
upon salt meat, during the American war, were much 
less afflicted with the intermitting fever, than the neigh- 
bouring country people ; and, it is well known, the 
American army was much less afflicted with summer 
and autumnal fevers, after they exchanged their fresh 
meat, for rations of salted beef and pork. Ardent spirits 
should be used cautiously, for, when taken long enough to 
do good, they create a dangerous attachment to them. A 
strong infusion of any bitter herb in water, taken upon 
an empty stomach, is a cheap substitute for all the above 
liquors where they cannot be afforded. The Peruvian 
bark has in many instances been used with success as a 
preventive of the mild grades of the summer and autum- 
nal fevers of our country. 

2. An equable and constant perspiration. This should 
be kept up by all the means formerly mentioned for that 
purpose. 

3. Avoiding certain exciting causes, particularly great 
heat and cold, fatigue, long intervals between meals, in- 
temperance, and the morning and evening air, more 
especially during the lunar periods formerly mentioned. 
Dr. Lind says, the farmers of Holdernesse, in England, 
who go out early to their work, are seldom long lived, 
probably from their constitutions being destroyed by fre- 
qu t attacks of intermitting fevers to which that prac- 
tls jx poses them. Where peculiar circumstances of 

\ess render it necessary for persons to inhale the 
m ling air, care should be taken never to do it without 
ii eating a cordial breakfast. 

/he intestinal state of our summer and autumnal dis- 

rcquires several specific means to prevent it, different 



128 ON THE MEANS OF PREVENTING 

from those which have been advised to defend the blood- 
vessels from fever. Unripe and decayed fruit should be 
avoided, and that which is ripe and sound should nof be 
eaten in an excessive quantity. Spices, and particularly 
Cayenne pepper, and the red pepper of our country, 
should be taken daily with food. Mr. -De war, a British 
surgeon, tells us, the French soldiers, while in Egypt, 
carried pepper in boxes with them, wherever they went, 
to eat with the fruits of the country, and thereby often 
escaped its diseases. The whole diet, during the preva- 
lence of intestinal diseases, when they are not highly in- 
flammatory, should be of a cordial nature. A dysentery 
prevailed, a few years ago, upon the Potomac, in a part 
of the country which was inhabited by a number of pro- 
testant and catholic families. The disease was observed 
to exist only in the former. The latter, who ate of salted 
fish every Friday, and occasionally on other days of the 
week, very generally escaped it. In the year 1759, a dy- 
sentery broke out in the village of Princetown, in New- 
Jersey, and affected many of the students of the college. 
It was remarked, that it passed by all those boys who 
came from the cities of New-York and Philadelphia. This 
was ascribed to their having lived more upon tea and 
coffee than the farmers' sons in the college ; for those 
cordial articles of diet were but rarely used, fifty years 
ago, in the farm houses of the middle states of America. 
I mentioned formerly that the cordial diet of the inhabi- 
tants of our cities was probably the reason why the dy- 
sentery so seldom prevailed as an epidemic in them. 

Another means of preventing the dysentery is, by avoid- 
ing costiveness, and by occasionally taking purging physic, 
even when the bowels are in their natural state. A militia 
captain, in the Pennsylvania service, preserved his whole 
company from a dysentery which prevailed in a part of 
the American army at Amboy, in the year 1776, by giv- 
ing each of them a purge of sea-water. He preserved his 
family, and many of his neighbours, some years after- 
wards, from the same disease, by dividing among them 
a few pounds of purging salts. It was prevented, a few years 
ago, in the academy of Bordentown, in New-Jersey, by 
giving all the boys molasses, inlarge quantities, in their 



SUMMER AND AUTUMNAL DISEASE. 129 

diet and drinks. The molasses probably acted only by 
keeping the bowels in a laxative state. 

As the dysentery is often excited by the dampness of 
the night air, great care should be taken to avoid it, and, 
when necessarily exposed to it, to defend the bowels by 
more warmth than other parts of the body. The Egyp- 
tians, Mr. Dewar says, tie a belt about their bowels for 
that purpose, and with the happiest effects. 

II. I come now, according to the order I proposed, to 
mention the means of preserving whole cities or commu- 
nities from the influence of those morbid exhalations 
which produce the different forms of summer and autum- 
nal disease, and, in particular, that which is of a malig- 
nant nature. 

As the flight of a whole city is rarely practicable, it will 
be necessary to point out the means of destroying the 
morbid miasmata. 

1. Where the putrid matters which emit them are of a 
small extent, they should be covered with water or earth. 
Purchas tells us, 500 persons less died of the plague 
the day after the Nile overflowed the ground which had 
emitted the putrid exhalations that produced it, than had 
died the day before. A bilious fever was once checked 
in Brabant by inundating the marsh from whence the mi- 
asmata came that produced it. During the prevalence of 
a malignant fever, it will be unsafe to remove putrid 
matters. A plague was generated by an attempt to re- 
move the filth which had accumulated on the banks of 
the waters which surround the city of Mantua, during the 
summer and autumnal months.* Even a shower of rain, 
by disturbing the green pellicle which is sometimes form- 
ed over putrid matters, I shall mention in another place, 
has let loose exhalations that have produced a pestilential 
disease. 

2. Impregnating the air with certain effluvia, which act 
either by destroying miasmata by means of mixture, or 
by exciting a new action in the system, has, in some in- 
stances, checked the progress of a malignant fever. The 
air extricated from fermenting wines, during a plentiful 
vintage, Vansweiten tells us, has once checked the rava 

* Rursevus. 
L. IV. R 



130 ON THE MEANS OF PREVENTING 

ges of a plague in Germany. Ambrose Parey informs 
us, the plague was checked in a city in Italy by killing 
all the cats and dogs in the place, and leaving them to 
putrefy in the streets. Mr. Bruce relates, that all thos* 
persons who lived in smoky houses, in one of the coun- 
tries which he visited, escaped bilious fevers, and Dr. 
Clark mentions an instance, in which several cooks, who 
were constantly exposed to smoke, escaped a fever which 
afFected the whole crew of a galley. The yellow fever 
has never appeared within the limits of the effluvia of the 
sal ammoniac manufactory, nor of the tan-pits in the 
suburbs of Philadelphia, nor has the city of London been 
visited with a plague since its inhabitants have used sea- 
coal for fuel. But other causes have contributed more 
certainly to the exemption of that city from the plague 
for upwards of a century, one of which shall be mention- 
ed under our next head. 

3. Desquenette tells us, the infection of the plague 
never crosses the Nile, and that it is arrested by means 
of ditches, dug and filled with water for that purpose. 
Dr. Whitman has remarked, that the plague never pass- 
es from Abydos, on the Turkish, to Mito, on the Euro- 
pean side of the water of the Dardanelles, which forms 
the entrance to Constantinople. The yellow fever has 
never been known to pass from Philadelphia to the Jersey 
shore, and the miasmata generated on the east side of the 
Schuylkill rarely infect the inhabitants of the opposite side 
of the river. Many persons found safety from the plague 
of London, in 1665, by flying to ships which lay in the 
middle of the Thames, and, it is well known, no instances 
of yellow fever occurred in those Philadelphia families 
that confined themselves to ships in the middle of the 
Delaware, in the year 1793. But three or four, of four 
hundred men, on board a ship of war called the Jason, 
commanded by captain Coteneuil, perished with an epi- 
demic yellow fever, in the year 1746, at St. Domingo, in 
consequence, Dr. Desportes says, of her hold being con- 
stantly half filled with water.* I have multiplied facts 
upon this subject, because they lead to important con- 
clusions. They shew the immense consequence of fre- 
quently washing the streets and houses of cities, both to 

*Vcl. I. p/161. 



SUMMER AND AUTUMNAL DISEASE. 131 

prevent and check pestilential fevers. What would be 
the effect of placing tubs of fresh water in the rooms of 
patients infected with malignant fevers, and in an atmos- 
phere charged wiih putrid exhalations ? Their efficacy 
in absorbing the matter which constitutes the odour of 
fresh paint, favours a hope that they would be useful for 
that purpose. I have mentioned an instance, in the Ac- 
count of the Yellow Fever in Philadelphia, in the year, 
1797, in which they were supposed to have been employ- 
ed with evident advantage. 

4. Intercepting the passage of miasmata to the inhabi- 
tants of cities. Varro in his Treatise upon Agriculture, 
relates, that his namesake Varro, a Roman general, was 
in great danger of suffering, with a large fleet and army, 
from a malignant fever at Conyra. Having discovered 
the course of the miasmata which produced it to be from 
the south, he fastened up all the southern windows and 
doors of the houses in which his troops were quartered, 
and opened new ones to the north, by which means he 
preserved them from the fever which prevailed in all the 
other houses of the town and neighbourhood. Mr. How- 
ard advises keeping the doors and windows, of houses 
which are exposed to the plague, constantly shut, except 
during the time of sunshine. 

5. Sir John Pringle tells us, that the inhabitants of 
Breda defend themselves from the morbid exhalations of 
a piece of marshy ground in its neighbourhood, in the 
season of bilious fevers, by overflowing it with water. 

Several other means have been recommended to pre- 
serve cities from malignant fevers during their prevalence, 
which are of doubtful efficacy, or evidently hurtful. 
They are, 

6. Strewing lime over putrid matters. Dr. Dalzelle 
says, he once checked a bilious fever, by spreading twelve 
barrels of lime on a piece of marshy ground, from whence 
the exhalations that produced it were derived*. A mix- 
ture of quick lime and ashes in water, when thrown into 
a privy, discharges from it a large quantity of offensive 
air, and leaves it afterwards without a smell. As this 
foul air is discharged into the atmosphere, it has been 

* Stu- les Maladies des Climats ChaiuR 



132 ON THE MEANS OF PREVENTING 

doubted whether the lime and ashes should be used for 
that purpose, after a malignant fever has made its ap- 
pearance. 

7. Mr. Quiton Morveau has lately proposed the mu- 
riatic gas as a means of destroying miasmata. However 
effectual it may be in destroying the volatile and foul 
excretions which are discharged from the human body in 
confined situations, as in filthy jails, hospitals, and ships, 
it is not calculated to oppose the seeds of a disease which 
exists in the atmosphere, and which are diffused over a 
large extent of city or country. Mr. Morveau ascribes 
great virtues to it, in checking the malignant fever in 
Cadiz, in 1801, but from the time at which it was used, 
being late in the autumn, there is more reason to believe 
it had run its ordinary course, or that it was destroyed by 
cold weather. 

8. The explosion of gunpowder has been recommended 
for checking pestilential diseases. Mr. Quiton Morveau 
says, it destroys the offensive odour of putrid exhalations, 
but does not act upon the fevers produced by them. 

9. Washing the floors of houses with a solution of 
alkaline salts in water, has been recommended by Dr. 
Mitchell, as an antidote to malignant fevers. As yet, I 
believe, there are no facts which establish the efficacy 
of the practice, when they are produced by exhalations 
from decayed vegetable and animal substances in a putrid 
state. 

10. Large fires have sometimes been made in cities, 
in order to destroy the miasmata of pestilential disease. 
They were obviously hurtful in the plague of London, in 
the year 1665. Dr. Hodges, who relates this fact, says, 
" Heaven wept for the mistake of kindling them, and 
mercifully put them out, with showers of rain." 

I cannot conclude this head, without lamenting the 
want of laws in all our states, to compel physicians to 
make public the first cases of malignant fever that come 
under their notice. The cry of fire is not more useful to 
save a city from destruction, than the early knowledge of 
such cases would be to save it from the ravages of pesti- 
lential and mortal epidemics. Hundreds of instances have 
occurred in all ages and countries, in which they might 



SUMMER AND AUTUMNAL DISEASE. 133 

have been stifled in their birth, by the means that have 
been mentioned, had this practice been adopted. But 
when, and where, will science, humanity, and govern- 
ment first combine to accomplish this salutary purpose? 
Most of our histories of mortal epidemics abound with 
facts which show a contrary disposition and conduct in 
physicians, rulers, and the people. I shall mention one 
of these facts only, to show how far we must travel over 
mountains of prejudice and error, before we shall witness 
that desirable event. It is extracted from the second 
volume of the Life of the late Empress of Russia. " The 
Russian army (says the biographer,) after defeating the 
Turks, on entering their territories were met by the 
plague, and brought it to their country, where the folly of 
several of their generals contributed to its propagation, 
as if they thought by a military word of command to alter the 
nature of things. Lieutenant-general Stoffeln, at Yassy, 
where the pestilence raged in the winter of 1770, issued pe- 
remptory orders that its name should not be pronounced ; 
even he obliged the physicians and surgeons to draw up a 
declaration in writing, that it was only a spotted/ever. One 
honest surgeon of the name of Kluge refused to sign it. 
In this manner the season of prevention was neglected. 
Several thousand Russian soldiers were by this means 
carried oft'. The men fell dead upon the road in heaps. 
The number of burghers that died was never known, as 
they had run into the country, and into the forests. At 
length the havoc of death reached the general's own peo- 
ple : he remained true to his persuasion, left the town, 
and went into the more perilous camp. But his intrepi- 
dity availed him nothing ; he died of the plague in July. 
1771 "* 

III. Let us now consider, in the last place, the means 
of exterminating malignant and other forms of the sum- 
mer and autumnal disease, by removing their causes. 
These means are, 

1. The removal or destruction of all those putrid 
matters formerly enumerated, which are capable of produ- 
cing fevers. Many of the institutions of the Jewish 

* The above disease appears to have been the camp fever, the origin 
and character of which, will be noticed in the next article. 



134 ON THE MEANS OF PREVENTING 

nation, for this purpose, are worthy of our imitation. The 
following verses contain a fund of useful knowledge upon 
this subject. — " Thou shalt have a place without the 
camp, whither thou shalt go forth abroad ; and shalt have 
a paddle upon thy weapon, and it shall be when thou 
wilt ease thyself abroad, thou shalt dig therewith, and 
shalt turn back, and cover that which cometh from thee; 
for the Lord thy God walketh in the midst of thy camp 
to deliver thee, therefore shall he see no unclean thing in 
thee, and turn away from thee." Deuteronomy, chapter 
xxiii. verses 12, 13, and 14. " But the flesh of the 
bullock, and his skin and his dung, shalt thou burn with 
jire without the camp." Exodus, chapter xxix. verse 14. 
The advantages of thus burying and removing all putrid 
matters, and of burning such as were disposed to a speedy 
putrefaction, in a crowded camp, and in a warm climate, 
are very obvious. Their benefits have often been realized 
in other countries. The United provinces of Holland 
hold their exemption from the plague, only by the tenor 
of their cleanliness. In the character given by Luther of 
Pope Julius, he says, " he kept the streets of Rome so 
clean and sweet, that there were no plagues nor sickness 
during his time." The city of Oxford was prepared to 
afford an asylum to the royal family of Great- Britain from 
the plague, when it ravaged London, and other parts of 
England, in the year 1665, only in consequence of its 
having been cleaned, some years before, by the Bishop of 
Winchester. In a manuscript account of the life of 
Doctor, afterwards Governor Colden, of New-York, 
there is the following fact. It was first communicated to 
the public in the daily gazette of the capital of that state, 
on the 30th of October, 1799. " A malignant fever hav- 
ing raged with exceeding violence for two summers 
successively in the city of New-York, about forty 
years ago, he communicated his thoughts to the pub- 
lic, on the most probable cure of the calamity. He 
published a little treatise on the occasion, in which he 
collected the sentiments of the best authority, on the bad 
effects of stagnating waters, moist air, damp cellars, filthy 
shores, and dirty streets. He showed how much these 
nuisances prevailed in many parts of the city, and pointed 



SUMMEH AND AUTUMNAL DISEASE. 135 

out the remedies. The corporation of the city voted him 
their thanks, adopted his reasoning, and established a plan 
for draining and cleaning the city, which "was attended 
with the most happy effects." The advantages of burn- 
ing offal matters, capable by putrefaction of producing 
fevers, has been demonstrated by those housekeepers, 
who instead of collecting the entrails of fish and poultry, 
and the parings and skins of vegetables, in barrels, 
instantly throw them into their kitchen fires* The fami- 
lies of such persons are generally healthy. 

2. In the construction of cities, narrow streets and 
alleys should be carefully avoided. Deep lots should be 
reserved for yards and gardens for all the houses, and 
subterraneous passages should be dug to convey, when 
practicable, to running water, the contents of privies, and 
the foul water of kitchens. In cities that are wholly 
supplied with fresh water by pipes from neigbouring 
springs or rivers, all the evils from privies might be pre- 
vented by digging them so deep as to connect them with 
water. Great advantages it has been suggested, would 
arise in the construction of cities, from leaving open 
squares, equal in number and size to those which are 
covered with houses. The light and dark squares of a 
chequer-board might serve as models for the execution of 
such a plan. The city of London, which had been 
afflicted nearly every year for above half a century by the 
plague, has never been visited by it since the year 166G. 
In that memorable year, while the inhabitants were vent- 
ing their execrations upon a harmless bale of silks im- 
ported from Holland, as the vehicle of the seeds of their 
late mortal epidemic, Heaven kindly pointed out, and 
removed its cause, by permitting a fire to destroy whole 
streets and lanes of small wooden buildings, which had 
been the reservoirs of filth for centuries, and thereby the 
sources of all the plagues of that city.* Those streets and 
lanes were to London, what Water-street and Farmcr's- 
vow are to Philadelphia, Fell's- point to Baltimore, the 

* A proposal was made to replace the houses that had been burnt, by 
similar buildings, and upon the same space of ground. Sir Christopher 
opposed it, and with the following argument : " By so doing, you 
will show you have not deserved tin- late I . 



136 ON THE MEANS OF PREVENTING 

slips and docks to New- York, and Water-street to the 
town of Norfolk. 

3. Where the different forms of summer and autumnal 
disease arise from marsh exhalations, they should be de- 
stroyed by drains, by wells communicating with their 
subterraneous springs, or by cultivating upon them cer- 
tain grasses, which form a kind of mat over the soil, and, 
when none of these modes of destroying them is practi- 
cable, by overflowing them with water. 

I have met with many excellent quotations from a 
work upon this part of our subject, by Tozzetti, an 
Italian physician, from which, I have no doubt, much 
useful information might be obtained. The Rev. Thomas 
Hall, to whom I made an unsuccessful application for 
this work, speaks of it, in his answer to my letter, in the 
following terms. " It is in such high estimation that the late 
emperor Leopold, when grand duke of Tuscany, caused it 
to be re-printed at his own expense, and presented it to his 
friends. The consequence of this was, it influenced the 
owners of low marshy grounds, in the neighbourhood of 
the river Arno, to drain and cultivate them, and thereby 
rendered the abode of noxious air, and malignant fevers, 
a terrestrial paradise." 

4. The summer and autumnal diseases of our country 
have often followed the erection of mill-dams. They may 
easily be obviated by surrounding those receptacles of 
water with trees, which prevent the sun's acting upon 
their shores, so as to exhale miasmata from them. Trees 
planted upon the sides of creeks and rivers, near a house, 
serve the same salutary purpose. 

5. It has often been observed, that families enjoy good 
health, for many years, in the swamps of Delaware and 
North-Carolina, while they are in their natural state, but 
that sickness always follows the action of the rays of the 
sun upon the moist surface of the earth, after they are 
cleared. For this reason, the cultivation of a country 
should always follow the cutting down of its timber, in or- 
der to prevent the new ground becoming, by its exhala- 
tions, a source of disease. 

6. In commercial cities, no vessel that arrives with a 
cargo of putrescent articles should ever be suffered to 



SUMMER AND AUTUMNAL DISEASE. 157 

approach a wharf, before the air that has been confined in 
her hold has been discharged. The same thing should 
be done after the arrival of a vessel from a distant or 
hot country, though her cargo be not capable of putre- 
faction, for air acquires a morbid quality by stagnating 
contiguous to wood, under circumstances formerly men- 
tioned. 

All these modes of removing the causes of malignant 
and yellow fevers, and of promoting strict and universal 
cleanliness, are of more consequence in the middle and 
northern states of America, than in countries uniformly 
warm, inasmuch as the disease may be taken as often as 
our inhabitants are exposed to its sources. In the West- 
Indies, a second attack of the yellow fever is prevented 
by the insensibility induced upon the system, by its being 
constantly exposed to the impressions of heat and exha- 
lation. After a seasoning, as it is called, or a residence 
of two or three years in those islands, the miasmata affect 
the old settlers, as they do the natives, only with mild 
remittents. Nearly the same thing takes place at Madras, 
in the East-Indies, where Dr. Clark says, the exhala- 
tions which bring on bilious fevers, colic, cholera, and 
spasmodic affections in new comers, produce a puking in 
the morning, only in old residents. But very different is 
the condition of the inhabitants of the middle and north- 
ern states of America, in whom the winters prevent the 
acquisition of habits of insensibility to the heat and exha- 
lations of the previous summers, and thus place them 
every year in the condition of new comers in the West 
and East-Indies, or of persons who have spent two or 
three years in a cold climate. This circumstance in- 
creases the danger of depopulation from our malignant 
epidemics, and should produce corresponding exertions 
to prevent them. 

In enumerating the various means of preventing and 
exterminating the malignant forms of fever, it may ap- 
pear strange' that I have said nothing of the efficacy of 
quarantines for that purpose. Did I believe these pages 
would be read only by the citizens of Pennsylvania, I 
would do homage to their prejudices, by passing over 
this subject by a respectful and melancholy silence ; but as 

VOL. IV. 



138 ON THE MEANS OF PREVENTING 

it is probable they will fall into the hands of physicians and 
citizens of other states, I feel myself under an obligation 
to declare, that I believe quarantines of no efficacy in pre- 
venting the yellow fever, in any other way than by exclu- 
ding the unwholesome air that is generated in the holds 
of ships, which may be done as easily in a single day, as 
in weeks or months. They originated in error, and have 
been kept up by a supine and traditional faith in the 
opinions and conduct of our ancestors in medicine. Mil- 
lions of dollars have been wasted by them. From their 
influence, the commerce, agriculture, and manufactures 
of our country have suffered for many years. But this 
is not all. Thousands of lives have been sacrificed, by 
that faith in their efficacy, which has led to the neglect of 
domestic cleanliness. Distressing as these evils are, 
still greater have originated from them ; for a belief in 
the contagious nature of the yellow fever, which is so 
solemnly enforced by the execution of quarantine laws, 
has demoralized our citizens. It has, in many instances, 
extinguished friendship, annihilated religion, and viola- 
ted the sacraments of nature, by resisting even the loud 
and vehement cries of filial and parental blood. 

While I thus deny the yellow fever to be the offspring 
of a specific contagion, and of course incapable of 
being imported so as to become an epidemic in any 
country, I shall admit presently, that the excretions of a 
patient in this disease may, by confinement, become so 
acrid as to produce, under circumstances to be men- 
tioned hereafter, a similar disease, in a person, but from 
this person it cannot be communicated, if he possess 
only the common advantages of pure air and cleanliness, 
to enforce a quarantine law, therefore, under such a con- 
tingent circumstance, and at the expense of such a pro- 
fusion of blessings as have been mentioned, is to imi- 
tate the conduct of a man, who, in attempting to kill a 
fly upon his child's forehead, knocked out his brains. 

From the detail that has been given of the sources of 
malignant fevers, and of the means of preventing them, 
it is evident that they do not exist by an unchangeable 
law of nature, and that Heaven has surrendered every 
part of the globe to man, in a state capable of being in- 



SUMMER AND AUTUMNAL DISEASE. 139 

habited, and enjoyed. The facts that have been men- 
tioned show further, the connection of health and lon- 
gevity, with the reason and labour of man. 

To every natural evil the Author of Nature has kindly 
prepared an antidote. Pestilential fevers furnish no ex- 
ception to this remark. The means of preventing them 
are as much under the power of human reason and in- 
dustry, as the means of preventing the evils of lightning 
and common fire. I am so satisfied of the truth of this 
opinion, that I look for a time when our courts of law 
shall punish cities and villages, for permitting any of the 
sources of bilious and malignant fevers to exist within 
their jurisdiction. 

I have repeatedly asserted the yellow fever of the 
United States not to be contagious. I shall now mention 
the proofs of that assertion, and endeavour to explain 
instances of its supposed contagiousness upon other 
principles. 



FACTS, 

INTENDED TO PROVE 

THE YELLOW FEVER 

NOT TO BE CONTAGIOUS. 



FACTS, &c. 



WHEN fevers are communicated from one person 
to another, it is always in one of the following ways. 
1. By secreted matters. 2. By excreted matters. The 
small-pox and measles are communicated in the former 
way ; the jail, or, as it is sometimes called, the ship, or 
hospital fever, is communicated only by means of the 
excretions of the body. The perspiration, by acquiring 
a morbid and irritating quality more readily than any 
other excretion, in consequence of its stagnation and con- 
finement to the body in a tedious jail fever, is the princi- 
pal means of its propagation. The perspiration * is, 
moreover, predisposed to acquire this morbid and acrid 
quality by the filthiness, scanty, or bad aliment, and de- 
pression of mind, which generally precede that fever. It 
is confined to sailors, passengers, soldiers, prisoners, and 
patients, in foul and crowded ships, tents, jails, and hos- 
pitals, and to poor people who live in small, damp, and 
confined houses. It prevails chiefly in cool and cold 
weather, but is never epidemic ; for the excreted mat- 
ters which produce the fever do not float in the external 
atmosphere, nor are they communicated, so as to produce 
disease, more than a few feet from the persons who ex- 
hale them. They are sometimes communicated by means 
of the clothes which have been worn by the sick, and 
there have been instances in which the fever has been 
produced by persons who had not been confined by it, 
but who had previously been exposed to all the causes 
which generate it. It has been but little known in the 
the United States since the revolutionary war, at which 
time it prevailed with great mortality in the hospitals and 
camps of the American army. It has now and then ap- 
peared in ships that were crowded with passengers from 

• The deleterious nature of this fluid, and its disposition to create dis- 
ease, under the above circumstances, has heen happily illustrated by Dr. 
Mitchill, in an ingenious letter to Dr. Duncan, of Ldiuburgh, published in- 
'he fourth volume of the Annals of Medicine. 



144 YELLOW FEVER NOT CONTAGIOUS. 

different parts of Europe. It is a common disease in 
the manufacturing towns of Great-Britain, where it has 
been the subject of several valuable publications, par- 
ticularly by Dr. Smith, and Dr. John Hunter. Dr. 
Haygarth has likewise written upon it, but he has unfor- 
tunately confounded it with the West- India and Ameri- 
can yellow fever, which differs from it in prevailing chiefly 
in warm climates and seasons ; in being the offspring of 
dead and putrid vegetable and animal matters ; in affect- 
ing chiefly young and robust habits ; in being generally 
accompanied with a diseased state of the stomach, and 
an obstruction or preternatural secretion and excretion 
of bile : in terminating, most commonly, within seven 
days ; in becoming epidemic only by means of an im- 
pure atmosphere ; and in not furnishing ordinarily those 
excretions which, when received into other bodies, re- 
produce the same disease. 

I have been compelled to employ this tedious descrip- 
tion of two forms of fever, widely different from each 
other in their causes, symptoms, and duration, from the 
want of two words which shall designate them. Dr. 
Miller has boldly and ingeniously proposed to remedy 
this deficiency in our language, by calling the former 
idio- miasmatic, and the latter koino-miasmatic fevers, 
thereby denoting their private or personal and their public 
or common origin.* My best wishes attend the adop- 
tion of those terms ! 

I return to remark, that the yellow fever is not conta- 
gious in its simple state, and that it spreads exclusively 
by means of exhalations from putrid matters, which are 
diffused in the air. This is evident from the following 
considerations : 

1. It does uot spread by contagion in the West-Indies, 
this has been proved in the most satisfactory manner by 
Drs. Hillary, Huck, Hunter, Hector, M'Lean, Clark, 
Jackson, Borland, Pinckard, and Scott. Dr. Chisholm 
stands alone, among modern physicians, in maintaining a 
contrary opinion. It would be easy to prove, from many 
passages in the late edition of the doctor's learned and 
instructive volumes, that he has been mistaken ; and that 
* Medical Repnsitoiy, he:;ade ii. i 



YELLOW FEVER NOT CONTAGIOUS. 145 

the disease was an endemic of every island in which he 
supposed it to be derived from contagion. A just idea 
of the great incorrectness of all his statements, in favour 
of his opinion, may be formed from the letter of J.- F. 
Eckard, Esq. Danish consul, in Philadelphia, to Dr. 
James Mease, published in a late number of the New- 
York Medical Repository.* 

2. The yellow fever does not spread in the country, 
when carried thither from the cities of the United States. 

3. It does not spread in yellow fever hospitals, when 
they are situated beyond the influence of the impure air 
in which it is generated. 

4. It does not spread in cities (as will appear hereafter) 
from any specific matter emitted from the bodies of sick 
people. 

5. It generally requires the co-operation of an exci- 
ting cause, with miasmata, to produce it. — This is 
never the case with diseases which are universally ac- 
knowledged to be contagious. 

6. It is not propagated by the artificial means which 
propagate contagious diseases. Dr. Ffirth inoculated 
himself above twenty times, in different parts of his body, 
with the black matter discharged from the stomach of 
patients in the yellow fever, and several times with the 
serum of the blood, and the saliva of patients ill with 
that disease, without being infected by them ; nor was 
he indisposed after swallowing half an ounce of the black 
matter recently ejected from the stomach, nor by expos- 
ing himself to the vapour which was produced by throw- 
ing a quantity of that matter upon iron heated over a 
fire.f 

To the first four of these assertions there are some 
seeming exceptions in favour of the propagation of this 
fever by contagion. I shall briefly mention them, and 
endeavour to explain them upon other principles. 

The circumstances which seem to favour the commu- 
nication of the yellow fever from one person to another, 

* For February, March, and April, 1801. 

t Inaugural Dissertation on Malignant Fever, Sec. publi<toed in June, 
7804. 

VOL. IV. T 



146 YELLOW FEVER NOT CONTAGIOUS. 

by means of what has been supposed to be contagion, are 
as follows : 

1. A patient being attended in a small, filthy, and close 
room. The excretions of the body, when thus accumu- 
lated, undergo an additional putrefactive process, and ac- 
quire the same properties as those putrid animal matters 
which are known to produce malignant fevers. I have 
heard of two or three instances in which a fever was pro- 
duced by these means in the country, remote from the 
place where it originated, as well as from every external 
source of putrid exhalation. The plague is sometimes 
propagated in this way in the low and filthy huts which 
compose the alleys and narrow streets of Cairo, Smyrna* 
and Constantinople. 

2. A person sleeping in the sheets, or upon a bed im- 
pregnated with thei sweats or other excretions, or being 
exposed to the smell of the foul linen, or other clothing 
of persons who had the yellow fever. The disease here, 
as in the former case, is communicated in the same way 
as from any other putrid animal matters. It was once 
received in Philadelphia from the effluvia of a chest of 
unwashed clothes, which had belonged to one of our citi- 
zens who had died with it in Barbadoes ; but it extend- 
ed no further in a large family, than to the person who 
opened the chest. I have heard of but two instances 
more of its having been propagated by these means in the 
United States, in which case the disease perished with the 
unfortunate subjects of it. 

To the above insulated cases of the yellow fever being 
produced by the clothing of persons who had died of it, 
I shall oppose a fact communicated to me by Dr. Mease. 
While the doctor resided at the lazaretto, as inspector of 
sickly vessels, between May, 1794, and the same month 
in 1798, the clothing contained in the chests and trunks 
of all the seamen and others, belonging to Philadelphia, 
who had died of the yellow fever in the West-Indies, or 
on their passage home, and the linen of all the persons 
who had been sent from the city to the lazaretto with 
that disease, amounting in all to more than one hundred, 
were opened, exposed to the air, and washed, by the fam- 



YELLOW FEVER NOT CONTAGIOUS. 147 

ily of the steward of the hospital, and yet no one of them 
contracted the least indisposition from them. 

I am disposed to believe the linen, or any other cloth- 
ing of a person in good health that had been strongly im- 
pregnated with sweats, and afterwards suffered to putrefy 
in a confined place, would be more apt to produce a yel- 
low fever in a summer or autumnal month, than the linen 
of a person who had died of that disease, with the usual 
absence of a moisture on the skin. The changes which 
the healthy excretions by the pores undergo by putrefac- 
tion, may easily be conceived, by recollecting the offen- 
sive smell which a pocket handkerchief acquires that has 
been used for two or three days to wipe 1 away the sweat 
of the face and hands in warm weather.* 

3. The protraction of a yellow fever to such a period 
as to dispose it to assume the symptoms, and to generate 
the peculiar and highly volatilised exhalation from the 
pores of the skin which takes place in the jail fever. I am 
happy in finding I am not the author of this opinion. Sir 
John Pringle, Dr. Monro, and Dr. Hillary, speak of a con- 
tagious fever produced by the combined action of marsh 
and human miasmata. The first of those physicians sup- 
poses the Hungarian bilious fever, which prevailed over 
the continent of Europe in the seventeenth century, was 
sometimes propagated in this way, as well as by marsh 
and other putrid exhalations. Dr. Richard Pearson, in 
his observations upon the bilious fevers which prevailed 
in the neighbourhood of Birmingham, in England, in the 
the years 1797, 1798, and 1799, has the following remark : 
" In its first stage, this fever did not appear to be con- 
tagious, but it evidently was so after the eleventh and 
fourteenth day, when the typhoid state was induced*.'' 
As this protracted state of bilious fever rarely occurs in 
our country, it has seldom been communicated in this 
way. 

It is not peculiar, I believe, to a bilious and yellow 
fever, when much protracted beyond its ordinary duration 
to put on the symptoms of the jail fever. The same ap>. 
pearances occur in the pleurisy, and in other, of what Dr. 

* See Van Sweiten on Epidemic Diseases, Aphorism 1408. 
t Page 13. 



148 YELLOW FEVER NO f CONTAGIOUS. 

Sydenham calls intercurrent fevers, all of which I have 
no doubt, under certain circumstances of filth, confine- 
ment, and long duration, would produce a fever in per- 
sons who were exposed to it. This fever, if the weather 
were cold, would probably put on inflammatory symp- 
toms, and be added, in our nosologies, to the class of 
contagious diseases. 

From the necessary influence of time, in thus render- 
ing fevers of all kinds now and then contagious by ex- 
cretion, it follows, that the yellow fever, when of its usual 
short duration, is incapable of generating that excretion, 
and that, instead of being considered as the only form of 
bilious fever that possesses a power of propagating itself, 
it should be considered as the only one that is devoid 
of it. 

4. Miasmata, whether from marshes, or other external 
sources, acting upon a system previously impregnated 
with the excreted matters which produce the jail or ship 
fever. Mr. Lempriere informs us, that he saw what were 
supposed to be cases of yellow fever communicated by 
some sailors who brought the seeds of the ship fever with 
them to the island of Jamaica. The fevers which affected 
most of the crews of the Husssr frigate, mentioned by 
Dr. Trotter*, and of the Busbridge Indiaman, described 
by Mr. Brycef, appear to have been the effect of the 
combined operation of foul air in those ships, and human 
excretions, upon their systems. The disease was barely 
tinged with bilious symptoms, and hence the facility with 
which it was cured, for the jail fever more readily yields 
to medicine than the yellow fever. The former was pro- 
bably excited by some latent exhalation from dead mat- 
ters in the holds of the ships, and hence we find it ceased 
on shore, where it was deprived of its exciting cause. It 
is true, great pains were taken to clean the hold and decks 
of the Busbridge, but there are foul matters which ad- 
here to the timbers of ships, and which, according to 
Dr. Lind, are sometimes generated by those timbers when 
new, v that are not to be destroyed by any of the common 
means employed for that purpose. Of this Dr. Kollock 
has furnished us with a most satisfactory proof, in his 

* Mcdicina Nautica, p. 360. f Annuls of Medicine, vol. i. p. llfrf 



YELLOW FEVER NOT CONTAGIOUS. 149 

history of the yellow fever, which prevailed on board of 
"the frigate General Greene, on her voyage to the Havanna, 
in the year 1799. " The air in the hold of the vessels 
(says the doctor) was so contaminated, as to extinguish 
lights immediately, and candles in the cockpit were al- 
most as useless from the same cause. The fish were 
thrown overboard, and the decks washed and scoured, 
the ventilator and wind sails put in motion, and every 
measure of purefication adopted that their situation al- 
lowed ; notwithstanding these precautions disease invaded 
us. The men were unceasing in their exertions to purify 
the ship ; washing, scouring with vinegar, burning pow- 
der and vinegar, old junk, and sulphur, added to constant 
ventilation, proved unequal even to the amelioration of 
their calamities, while they were in the latitude of great 
heat. After the removal of the sick, the ship was dis- 
burdened of her stores, ballast, &c. cleansed and white- 
washed throughout ; still new cases occurred for nearly 
two months. Some days, two, three, or four were sent 
off to the hospital, which would seem to indicate the re- 
tention of some portion of this noxious principle, which 
was lodged beyond the reach of the cleaning process." 
That this noxious principle or matter existed in the ship, 
and not in the bodies of the crew, is evident from its not 
having been communicated, in a single instance, by a 
hundred of them who were sent to an hospital on Rhode- 
Island, notwithstanding an intercourse sufficient to propa- 
gate it was necessarily kept up with the inhabitants. Even 
their nurses did not take it.* 

5. A fifth instance in which contagion has been sup- 
posed to take place in the yellow fever is, where the ex- 
halation from the excretions of a patient in that disease 
acts as an exciting cause, in persons previously impreg- 
nated with the marsh, or other external miasmata, which 
produce it. The activity of this exhalation, even when 
it is attended with no smell, is so great, as to induce 
sickness, head-ach, vertigo, and feinting. It is not pe- 
culiar to the exhalations from such patients to produce 
morbid effects upon persons who visit them. The odour 
emitted by persons in the confluent small-pox has been 
* Medical Repository, vol. iv. No. 1. 



150 YELLOW FEVER NOT CONTAGIOUS* 

known to produce the safme symptoms together with a 
subsequent fever and apthous sore throat. This has been 
remarked long ago by Dr. Lind, and latterly by Dr. 
Willan, in his Reports of the diseases of London. | That 
the yellow fever is often excited in this way, without the 
intervention of a supposed specific contagion, I infer from 
its sometimes spreading through whole families, who have 
breathed the same impure atmosphere with the person 
first infected by the fever. This is more especially the 
case where the impression made by the exhalation from 
the sick person is assisted by fear, fatigue, or anxiety of 
mind in other branches of the family. In favour of this 
mode of exciting the yellow fever, Dr. Otto communi- 
cated to me the following fact. In the autumn of the year 
1798, it prevailed upon the shores of the Delaware, in 
Gloucester county, in New-Jersey. A mild remittent 
prevailed at the same time on high grounds, a few miles 
from the river. During this time, the Doctor observed, 
if a person who had inhaled the seeds of the yellow fever 
in Philadelphia afterwards came into a family near the 
river, the same disease appeared in several instances in 
one or more branches of that family ; but where persons 
brought the fever from the city, and went into a family 
on the high grounds, where the mild remittents prevailed, 
there was not a single instance of a yellow fever being 
excited by them in any of its members. This fact is 
important, and of extensive application. It places the 
stimulus from the breath, or other exhalations of persons 
affected by the yellow fever, upon a footing with intem- 
perance, fatigue, heat, and all the common exciting 
causes of the disease ; none of which, it is well known, 
can produce it, except in persons who have previously 
inhaled the putrid miasmata, which in all countries are its 
only remote cause. The city of Philadelphia has furnish- 
ed, in all our yellow fever years, many additional proofs 
of the correctness of Dr. Otto's remark. In the months 
of July and August, when miasmata are generally local, 
and float chiefly near to their hot beds, the docks and holds 
of ships, persons who are affected by these miasmata, and 
sicken in other parts of the city, never communicate the 
* Page 13 aad 113. 



YELLOW FEVER NOT CONTAGIOUS. 151 

disease; but after the less prepared and heterogeneous 
filth of our whole city has been acted on by an autumnal, 
as well as summer sun, so as to emit pestilential exhala- 
tions into all our streets and alleys, the fever is now and 
then excited in the manner that has been mentioned by 
a single person in a whole family. The common inter- 
mittents of the southern states are often excited in the 
same way, without being suspected of spreading by con- 
tagion. Even the jail or hospital fever is vindicated by 
Dr. Hunter from the highly contagious nature which has 
been ascribed to it, upon the same principle. His words, 
which are directly to my purpose, are as follow : "In 
considering the extent and power of the contagion [[mean. 
ing of the jail or hospital fever,] I am not inclined to im- 
pute to this cause the fevers of all those who are taken 
ill in one family after the first, as they are all along ex- 
posed to the same vitiated air which occasions the first 
fever. In like manner, when a poor woman visits some 
of her sick neighbours, and is taken ill herself, and after- 
wards some of her children, 1 would not impute the dis- 
ease to infection alone ; she and her family having pre- 
viously lived in the same kind of vitiated air which ori- 
ginally produced the fever. If the cases in which the 
infection meets with the poison already half formed be 
excepted, the disease in itself will be found to be much 
less infectious than has been commonly supposed.*" 
By the modes of communicating the yellow fever which 
have been admitted, the dysentery, and all the milder 
forms of autumnal fevers, have been occasionally propa- 
gated, and perhaps oftcner than the first-named disease, 
from their being more apt to run on to the typhus or 
chronic state. Of this I could adduce many proofs, not 
only from books, but from my own observations; but 
none of these diseases spread by contagion, or become 
epidemic from that cause in any country. A contrary 
opinion, I know, is held by Dr. Cleghorn, and Dr. Clarke ; 
but they have deceived themselves, as they formerly de- 
ceived me, by not attending to the difference between 
secreted contagious and morbid excretions from the 
body, produced by the causes which have been enume- 
• Medical Transactions, vol iii p. 351. 



152 YELLOW FEVER NOT CONTAGIOUS. 

rated, and which are rare and accidental concomitants of 
bilious or summer diseases. 

6. The last instance of supposed contagiousness of the 
yellow fever is said to arise from the effluvia of a putrid 
body that has died of that disease. The effluvia in this 
case act either as the putrefied excretions mentioned under 
the first head, or as an exciting cause upon miasmata, 
previously received into the system. A dead body, in a 
state of putrefaction from any other disease, would produce, 
under the same circumstances of season and predisposition, 
the same kind and degrees of fever. 

The similarity of the fever induced by the means that 
have been enumerated, with the fever from which it was 
derived, has been supposed to favour the opinion of its 
being communicated by a specific contagion. But let it 
be recollected that the yellow fever is at the time of its 
being supposed to be thus received, the reigning epidemic, 
and that irritants of all kinds necessarily produce that 
disease. The morbid sweats which now and then produce 
an intermitting fever, and the alvine excretions which oc- 
casionally produce a dysentery, act only by exciting mor- 
bid actions in the system, which conform in their symp- 
toms to an immutable and universal law of epidemics. It 
is only when those two diseases generally prevail, that they 
seem to produce each other. 

Thus have I explained all the supposed cases of the 
contagiousness of the yellow fever. To infer from the 
solitary instances of it thus excited, is to reason as incor- 
rectly as to say the small-pox is not contagious, because 
we now and then meet with persons who cannot be infect- 
ed by it. 

From the explanation that has been given of the instan- 
ces in which the yellow fever has been supposed to spread 
by contagion, we are compelled to resort to certain nox- 
ious matters in the atmosphere, as the exclusive causes of 
the prevalence, not only of that fever, but (with a few 
exceptions) of all other epidemic diseases. It is true, we 
are as yet ignorant of the precise nature of those matters in 
the air which produce epidemics; but their effects are as 
certainly felt by the human body as the effects of heat, and 
yet who knows the nature of that great and universal prin- 
ciple of activity in our globe ? 



YELLOW FEVER NOT CONTAGIOUS. 153 

That the yellow fever is propagated by means of an 
impure atmosphere, at all times, and in all places, I infer 
from the following: facts : 

_ o 

1. It appears only in those climates and seasons of the 
year in which heat, acting upon moist animal and vegeta- 
ble matters, fills the air with their putrid exhalations. A 
vertical sun, pouring its beams for ages upon a dry soil ; 
and swamps, defended from the influence of the sun by 
extensive forests, have not in a single instance, produced 
this disease. 

2. It is unknown in places where a connection is not 
perceptible between it, and marshes, mill-ponds, docks, 
gutters, sinks, unventilated ships, and other sources of 
noxious air. The truth of this remark is established by 
the testimonies of Dr. Lind and Dr. Chisholm, and by 
many facts in Lenfpriere's excellent History of the Dis- 
eases of Jamaica. Dr. Davidson furnished me with a 
striking confirmation of their remarks, in the following 
extract from a letter, dated November 12th, 1794. " I 
have mentioned (says the doctor) an instance of the re- 
markable good health which the 66th regiment enjoyed at 
St. Vincents for several years, upon a high hill above the 
town, removed from all exhalations, and in a situation 
kept at all times cool by the blowing of a constant trade 
wind. They did not lose, during eighteen months, above 
two or three men (the regiment was completed to the 
peace establishment,) and during eight years they lost but 
two officers, one of whom, the quarter-master, resided 
constantly in town, and died from over fatigue ; the other 
arrived very ill from Antigua, and died within a few days 
afterwards." 

• In the United States, no advocate for the specific nature 
or importation of the yellow fever, has ever been able to 
discover a single case of it beyond the influence of an 
atmosphere rendered impure by putrid exhalations. 

It is no objection to the truth of this remark, that ma- 
lignant bilious fevers sometimes appear upon the summits 
of hills, while their declivities, and the vallies below, are 
exempted from them. The miasmata, in all these cases, 
arc arrested bv those heights, and are arrested by those 
heights, and are always to be traced to putrefaction and 
exhalation in their neighbourhood. Nor is it any objection 

Vol. iv. 

/ 



154 YELLOW FEVER NOT CONTAGIOUS. 

to the indissoluble connection between putrid exhalations 
and the yellow fever, which has been mentioned, that the 
disease sometimes appears in places remote from the 
source of miasmata in lime and place. The bilious pleu- 
risies, which occur in the winter and spring, after a sickly 
autumn, prove that they are retained in the body for many 
months, and although they are sometimes limited in their 
extent to a single house, and often to a village, a city, and 
the banks of a creek or river, yet they are now and then 
carried to a much greater distance. Mr. Lempriere, in 
his valuable Observations upon the Diseases of the British 
Army in Jamaica, informs us, that Kingston is sometimes 
rendered sickly by exhalations from a lagoon, which lies 
nine miles to the eastward of that town.* The greater or 
less distance, to which miasmata are carried from the place 
where they are generated, appears to depend upon their 
quantity, upon the force and duration of currents of wind 
which act upon them, and upon their being more or 
less opposed by rivers, woods, water, houses, wells, or 
mountains. 

3. It is destroyed, like its fraternal diseases, the common 
bilious and intermitting fevers, by means of long-continued 
and heavy rains.f When rains are heavy, but of short 
duration, they suspend it only in warm weather, but when 
they are succeeded by cold weather they destroy all the 
forms of bilious fever. The malignant tertians, described 
by Dr. Cleghorn, always ceased about the autumnal equi- 
nox ; for at that time, says the Doctor, " Rain falls in such 
torrents as to tear up trees by the roots, carry away cattle, 
break down fences, and do considerable mischief to the 
gardens and vineyards ; but, after a long and scorching 
summer, they are very acceptable and beneficial, for they 
mitigate the excessive heat of the air, and give a check to 
epidemical diseases. "J There are facts, however, which 
would seem to contradict the assertion that miasmata are 
suspended or destroyed by heavy rains. Dr. Lind, in his 
Treatise upon the Diseases of Hot Climates, mentions in- 
stances in which they suddenly created fevers. It is pro- 
bable, in these cases the rains may have had that effect, by 

* Vol. i. page M. 

t Clarke on the Diseases of Long Voyages to Hot Climates, page 115. 

% Diseases of Minorca, p. 8. 



ELVLOW FEVER NOT CONTAGIOUS. 155 

disturbing the pellicle which time often throws over the 
surface of stagnating pools of water, and putrid matters on 
dry land. I was led to entertain this opinion by a fact 
mentioned in a letter I received from Dr. Davidson, dated 
November 4th, 1794. " Being ordered (says the doctor) 
up to Barbadoes, last November, upon service, I found 
that the troops had suffered considerably by that formi- 
dable scourge, the yellow fever. The season had been 
remarkably dry. It was observed, a rainy season contri- 
buted to make the season healthier, excepting at Constitu- 
tion-Hill, where the sixth regiment was stationed, and 
where a heavy shower of rain seldom failed to bring back 
the fever, after it had ceased for some time. I found the 
barrack, where this regiment was, surrounded by a pond 
of brackish water, which being but imperfectly drained by 
the continuance of the drought, the surface was covered 
with a green scum, which prevented the exhalation of 
marshy putrefaction. After a heavy shower of rain, this 
scum was broken, and the miasmata evolved, and acted 
with double force, according to the time of their se- 
cretion." 

4. It is completely destroyed by frost. As neither 
rains nor frosts act in sick rooms, nor affect the bodies of 
sick people, they must annihilate the disease by acting 
exclusively upon the atmosphere. Very different in their 
nature are the small-pox and measles, which are propa- 
gated by specific contagion. They do not wait for the 
suns of July or August, nor do they require an impure 
atmosphere, or an exciting cause, to give them activity. 
They spread in the winter and spring, as well as in the 
summer and autumnal months : wet and dry weather do 
not arrest their progress, and frost, (so fatal to the yellow 
fever,) by rendering it necessary to exclude cold air from 
sick rooms, increases the force of their contagion, and 
thereby propagates them more certainly through a country. 

5. It is likewise destroyed by intense heat, and high 
winds. The latter, we are sure, like heavy rains and frost, 
do not produce that salutary effect by acting upon the 
bodies, or in the rooms of sick people. 

It is worthy of notice, that while the activity of mias- 
mata is destroyed by cold, when it desends to frost ; by 
heat, when it 'is so intense as to dry up all the sources of 



156 YELLOW FEVER NOT CONTAGIOUS. 

putrid exhalation ; by heavy rains, when they are succeed- 
ed by cool weather ; and by high winds, when they < re 
not succeeded by warm weather ; they are rendered more 
active by cool, warm, and damp weather, and by light 
winds. The influence of damp weather, in retaining and 
propagating miasmata, will be readily admitted, by recol- 
lecting how much more easily hounds track their prey, 
and how much more extensively odours of all kinds per- 
vade the atmosphere, when it is charged with moisture,, 
than in dry weather. 

It has been asked, if putrid matters produce malignant 
bilious fevers in our cities, why do they not produce them 
in Lisbon, and in several other of the filthiest cities in the 
south of Europe ? To this I answer, that filth and dirt are 
two distinct things. The streets of a city may be very 
dirty, that is covered with mud composed of inoffensive 
clay, sand, or lime, and, at the same time, be perfectly 
free from those filthy vegetable and animal matters which 
by putrefaction, contaminate the air. But admitting the 
streets of those cities to abound with the filthy matters that 
produce pestilential diseases in other countries, it is possi- 
ble the exhalations from them may be so constant, and so 
powerful, in their impressions upon the bodies of the in- 
habitants, as to produce, from habit, no morbid effects, or 
but feeble diseases, as was remarked formerly, is the case 
in the natives and old settlers in the East and West-Indies. 
But if this explanation be not satisfactory, it may be re- 
solved into a partial absence of an inflammatory consti- 
tution of the air, which, I shall say presently, must concur 
in producing pestilential diseases. Such deviations from 
uniformity in the works of Nature are universal. In the 
present instances, they no more invalidate the general pro- 
position of malignant fevers being every where of domes- 
tic origin, than the exemption of Ireland from venomous 
reptiles, proves they are not generated in other countries, 
or that the pleurisy and rheumatism are not the effects of 
the alternate action of cold and heat upon the body, 
because hundreds, who have been exposed to them under 
equal circumstances, have not been affected by those dis- 
eases. There may be other parts of the world in which 
putrid matters do not produce bilious malignant diseases 
from the causes that have been mentioned, or from some 



YELLOW FEVER NOT CONTAGIOUS. 157 

unknown cause, but I am safe in repeating, there never 
was a bilious epidemic yellow fever that could not be 
traced to putrid exhalation. 

It has been asked, if the yellow fever be not imported, 
why does it make its first appearance among sailors, and 
near the docks and wharves of our cities? I answer, this 
is far from being true. The disease has as often appear- 
ed first at a distance from the shores of our cities as near 
them, but, from its connection with a ship not being dis- 
covered, it has been called by another name. But where 
the first cases of it occur in sailors, I believe the seeds of 
it arc always previously received by them from our filthy 
docks and wharves, or from the foul air which is discharg- 
ed with the cargoes of the ships in which they have ar- 
rived, which seeds are readily excited in them by hard 
labour, or intemperance so as to produce the disease. 
That this is the case, is further evident from its appearing 
in them, only in those months in which the bilious fever 
prevails in our cities. 

It has been asked further, why were not these bilious 
malignant fevers more common before the years 1791, 
1792, and 1793 ? To this I answer, by repeating what 
was mentioned in another place*, that our climate has 
been gradually undergoing a change. The summers are 
more alternated by hot and cool, and wet and dry weather, 
than in former years. The winters are likewise less uni- 
formly cold. Grass is two or three weeks later in the 
spring in affording pasture to cattle than it was within the 
memory of many thousand people. Above all, the sum- 
mer has encroached upon the autumn, and hence the 
frequent accounts we read in our newspapers of trees blos- 
soming, of full grown strawberries and raspberries being 
gathered, and of cherries and apples, of a considerable 
size, being seen in the months of October and Novem- 
ber, in all the middle states. By means of this protraction 
of the heat of summer, more time is given for the gen- 
eration of putrid exhalations, and possibly for their great- 
er concentration and activity in producing malignant bil- 
ious diseases. 

It has been asked again, why do not the putrid mat- 
ters which produce the yellow fever in some years pro- 

* Account of the Clim e f Pennsylvania, vol. i. 



158 VELLOW 1-EVLR NOT COMTAGIOUS. 

duce it every year ? This question might be answered 
by asking two others. 1st. Why, if the yellow fever be 
derived from the West- Indies, was it not imported every 
year before 1791, and before the existence, or during the 
feeble and partial operation of quarantine laws ? It is no 
answer to this question to say, that a war is necessary to 
generate the disease in the islands, for it exists in some 
of them at all times, and the seasons of its prevalence in 
our cities have, in many instances, had no connection with 
war, nor with the presence of European armies in those 
and other sickly parts of the globe. During the seven 
years revolutionary war it was unknown as an epidemic 
in the United States, and yet sailors arrived in all our 
cities daily from sickly islands, in small and crowded ves- 
sels, and sometimes covered with the rags they had worn 
in the yellow fever, in British hospitals and jails. I ask, 
2dly, why does the dysentery (which is certainly a do- 
mestic disease) rise up in our country, and spread sick- 
ness and death through whole families and villages, and 
disappear from the same places for fifteen or twenty years 
afterwards ? 

The want of uniformity in the exhalations of our coun- 
try in producing those diseases depends upon their being 
combined with more or less heat or moisture ; upon the 
surface of the earth being completely dry, or completely 
covered with water;* upon different currents of winds, 
or the total absence of wind ; upon the disproportion of 
the temperature of the air in the day and night ; upon the 
quantity of dew ; upon the early or late appearance of 
warm or cold weather ; and upon the predisposition of 
the body to disease, derived from the quality of the ali- 
ments of the season. A similar want of uniformity in the 
annual operations of our climate appears in the size and 
quality of grain, fruits, and vegetables of all kinds. 

* In the Account of the Yellow Fever of 1793, the different and op- 
posite effects of a dry and rainy season in producing bilious fevers are 
mentioned from Dr. Dazilles. In the autumn of 1804, I have elsewhere 
remarked, after a summer in which there had fallen an unusual quantity 
of rain, the bilious fevers appeared chiefly on the high grounds in Perni 
sylvania, which were in a state of moisture, while scarcely a case of them 
appeared in the neighbourhood of marshes, or low grounds, owing to their 
being so completely covered with water, as to be incapable of generating, 
by putrefaction, the miasmata which produce those forms of disease 



YELLOW FEVER NOT CONTAGIOUS. 159 

But the greater violence and mortality of our bilious 
fevers, than in former years, must be sought for chiefly 
in an inflammatory or malignant constitution of the at- 
mosphere, the effects of which have been no less obvious 
upon the small-pox, measles, and the intercurrent fevers 
of Dr. Sydenham, than they are upon the summer and 
autumnal disease that has been mentioned. 

This malignant state of the air lias been noticed, under 
different names, by all the writers upon epidemics, from 
Hippocrates down to the present day. It was ascribed, 
by the venerable father of physic, to a " divine some- 
thing" in the atmosphere. Dr. Sydenham, whose works 
abound with references to it, supposes it to be derived 
from a mineral exhalation from the bowels of the earth. 
From numerous other testimonies of a belief in the in- 
fluence of the insensible qualities of the air, altering the 
character of epidemics, I shall select the following : 

" It is certain (says Dr. Moseley) that diseases un- 
dergo changes and revolutions. Some continue for a 
succession of years, and vanish when they have exhausted 
the temporary, but secret cause which produced them. 
Others have appeared and disappeared suddenly ; and 
others have their periodical returns." 

The doctor ascribes a malignant fever among the dogs 
in Jamaica (improperly called, from one of its symptoms, 
hydrophobia,) to a change in the atmosphere, in the year 
1783. It was said to have been imported, but experience, 
he says, proved the fact to be otherwise.* 

" This latent malignity in the atmosphere (says Baron 
Vansweiten) is known only by its effects, and cannot 
easily be reduced to any known species of acrimony." 
In another place he says, " It seems certain that this un- 
known matter disposes all the humours to a sudden and 
bad putrefaction."! 

Dr. John Stcdham has related many facts, in his Essay 
upon Insalutary Constitutions of the Air, which prove, 
that diseases are influenced by a quality in it, which, he 
says, " is productive of corruption," but which has hi- 
therto eluded the researches of physicians. J 

* Treatise upon Tropical Diseases, p 43, 44. 

t Commentaries on Boerhaave's Aphorisms, vol. v. p. 226, 230. 



160 YELLOW FEVER NOT CONTAGIOUS.' 

Mr. Lempriere, after mentioning the unusual mortality 
occasioned by the yellow fever, within the last five or six 
years, in the island of Jamaica, ascribes it wholly " to that 
particular constitution of atmosphere upon which the ex- 
istence of epidemics, at one period rather than another, 
depend."* 

Not only diseases bear testimony to a change in the 
atmosphere, but the whole vegetable and animal creation 
concur in it, proofs of which were mentioned in another 
place. Three things are remarkable with respect to this 
inflammatory constitution of the air. 

1. It is sometimes of a local nature, and influences the 
diseases of a city, or country, while adjoining cities and 
countries are exempted from it. 

2. It much oftener pervades a great extent of country. 
This was evident in the years 1793 and 1794, in the 
United States. During the same years, the yellow fever 
prevailed in most of the West-India islands. Many of 
the epidemics mentioned by Dr. Sims, in the first volume 
of the Medical Memoirs, affected, in the same years, the 
most remote parts of the continent of Europe. Even the 
ocean partakes of a morbid constitution of its atmosphere, 
and diseases at sea sympathise in violence with those of 
the land, at an immense distance from each other. This 
appears in a letter from a surgeon, on board a British ship 
of war, to Mr. Gooch, published in the third volume of 
his Medical and Surgical Observations. 

3. The predisposing state of the atmosphere to induce 
malignant diseases continues for several years, under all 
the circumstances of wet and dry, and of hot and cold 
weather. This will appear, from attending to the ac- 
counts which have been given of the weather, in all the 
years in which the yellow fever lias prevailed in Philadel- 
phia since 1792.f The remark is confirmed by all the 
records of malignant epidemics. 

It is to no purpose to say, the presence of the peculiar 
matter which constitutes an inflammatory or malignant 
state of the air has not been detected by any chemical 
agents. The same thing has been justly said of the ex- 
halations which produce the bilious intermitting, remit- 

* Vol. ii. p. SL f Vol. iii. and i\\ 



YELLOW FEVER NOT CONTAGIOUS.' 161 

ting, and yellow fever. No experiment that has yet been 
made, has discovered their presence in the air. The 
eudiometer has been used in vain for this purpose. In one 
experiment made by Dr. Gattani, the air from a marsh 
at the mouth of the river Tataline was found to be appa- 
rently purer by two degrees than the air on a neighbour- 
ing mountain, which was 2880 feet higher than the sea. 
The inhabitants of the mountain were notwithstanding 
healthy, while those who lived in the neighbourhood of the 
marsh were annually afflicted with bilious and intermitting 
fevers.* The contagions of the srnall-pox and measles 
consist of matter, and yet who has ever discovered this 
matter in the air? We infer the existence of those remote 
causes of disease in the atmosphere only from their ef- 
fects. Of the existence of putrid exhalations in it, there 
are other evidences besides bilious and yellow fevers. 
They are sometimes the objects of the sense of smelling. 
We see them in the pale or sallow complexions of the 
inhabitants of the countries which generate them, and we 
observe them occasionally in the diseases of several do- 
mestic animals. The most frequent of these diseases are 
inflammation, tubercles, and ulcers in the liver. Dr. 
Cleghorn describes a diseased state of that viscus in cat- 
tle, in an unhealthy part of the island of Minorca. Dr. 
Grainger takes notice of seweral morbid appearances in 
the livers of domestic animals in Holland, in the year 
1743. But the United States have furnished facts to il- 
lustrate the truth of this remark. Mr. James Wardrobe, 
near Richmond in Virginia, informed me, that in August, 
1794, at a time when bilious fevers were prevalent in his 
neighbourhood, his cattle were seized with a disease, 
which, I said formerly, is known by the name of the yel- 
low water, and which appears to be a true yellow fever. 
They were attacked with a staggering. Their eyes 
were muddy, or ferocious. A costiveness attended in 
all cases. It killed in two days. Fifty-two of his cat- 
tle perished by it. Upon opening the bodies of several 
of them, he found the liver swelled and ulcerated. 
The blood was dissolved in the veins. In the bladder of 

* Alibert's Dissertation sur lc9 Fievres Pernicieuses et Attaxques Inter- 
mittentes, p. 185. 

VOL. IV. X 



162 YELLOW FEVER NOT CONTAGIOUS. 

one of them, he found thirteen pints of blood and water. 
Similar appearances were observed in the livers of sheep 
in the neighbourhood of Cadiz, in the year 1799, during 
the prevalence of the yellow fever in that city. They 
were considered as such unequivocal marks of an un- 
wholesome atmosphere among the ancients, that they ex- 
amined the livers of domestic animals, in order to deter- 
mine on the healthy or unhealthy situation of the spot on 
which they wished to live. 

The advocates for the yellow fever being a specific 
disease, and propagated only by contagion, will gain noth- 
ing by denying an inflammatory constitution of the atmos- 
phere (the cause of which is unknown to us) to be ne- 
cessary to raise common remittents to that grade in which 
they become malignant yellow fevers ; for they are obliged 
to have recourse to an unknown quality in the air, every 
time they are called upon to account for the disease pre- 
vailing chiefly in our cities, and not spreading when it is 
carried from them into the country. The same reference 
to an occult quality in the air is had by all the writers 
upon the plague, in accounting for its immediate and 
total extinction, when it is carried into a foreign port. 

In speaking of the influence of an inflammatory con- 
stitution of the atmosphere in raising common bilious, to 
malignant yellow fevers, I wish not to have it supposed, 
that its concurrence is necessary to produce sporadic cases 
of that, or any other malignant disease. Strong ex- 
exciting causes, combined with highly volatilised and ac- 
tive miasmata, I believe, will produce a yellow fever at 
any time. I have seen one or more such cases almost 
every year since I settled in Philadelphia, and particularly 
when my business was confined chiefly to that class of 
people who live near the wharves, and in the suburbs, and 
who are still the first, and frequently the only victims of 
the yellow fever. 

It has been said, exultingly, that the opinion of the im- 
portation of the yellow fever is of great antiquity in our 
country, and that it has lately been admitted by the most 
respectable physicians in Britain and France, and sanc- 
tioned by the laws of several of the governments in Europe. 
Had antiquity, numbers, rank, and power been just ar- 



VELLOW FEVER NOT CONTAGIOUS. 163 

gumcnts in favour of existing opinions, a thousand truths 
would have perished in their birth, which have diffused 
light and happiness over every part of our globe. In 
favour of the ancient and general belief of the importation 
of the yellow fever, there are several obvious reasons. 
The idea is produced by a single act of the mind. It re- 
quires neither comparison nor reasoning to adopt it, and 
therefore accords with the natural indolence of man. It, 
moreover, flatters his avarice and pride, by throwing the 
origin of a mortal disease from his property and country. 
The principle of thus referring the origin of the evils of 
life from ourselves to others, is universal. It began in 
paradise, and has ever since been an essential feature in 
the character of our species. It has constantly led in- 
dividuals and nations to consider loathsome and danger- 
ous diseases as of foreign extraction. The venereal disease 
and the leprosy have no native country, if we believe all 
the authors who have written upon them. Prosper Al- 
pinus derives the plagues of Cairo from Syria, and the 
physicians of Alexandria import them from Smyrna or 
Constantinople. The yellow fever is said to have been 
first brought from Siam (where there are proofs it never 
existed) to the West- Indies, whence it is believed to be 
imported into the cities of the United States. From them, 
Frenchmen and Spaniards say it has been re-shipped, di- 
rectly or indirectly, to St. Domingo, Havannah, Malaga, 
Cadiz, and other parts of the world. Weak and absurd 
credulity ! the causes of the ferocious and mortal disease 
which we thus thrust from our respective ports, like the 
sin of Cain, " lie exclusively at our own doors." 

Lastly, it has been asserted, if we admit the yellow fever 
to be an indigenous disease of our cities, we shall destroy 
their commerce, and the value of property in them, by 
disseminating a belief, that the cause of our disease is 
fixed in our climate, and that it is out of the power of 
human means to remove it. The reverse of this suppo- 
sition is true. If it be an imported disease, our case is 
without a remedy ; for if, with all the advantages of quar- 
antine laws enforced by severe penalties, and executed in 
the most despotic manner, the disease has existed annual. 
Iv, in most of our cities, as an epidemic, or in sporadic 



164 YELLOW FEVER NOT CONTAGIOUS. 

cases ever since the year 1791, it will be in vain to ex- 
pect, from similar measures, a future exemption from it. 
Nothing but a belief in its domestic origin, and the adop- 
tion of means founded upon that belief, can restore the 
character of our climate, and save our commercial cities 
from destruction. Those means are cheap, practicable, 
and certain. They have succeeded, as I shall say pre- 
sently, in other countries. 

From the account that has been given of the different 
ways in which this disease is communicated from one 
person to another, and from the facts which establish its 
propagation exclusively through the medium of the at- 
mosphere, when it becomes epidemic, we may explain 
several things which belong to its history, that are inex- 
plicable upon the principle of its specific contagion. 

1. We learn the reason why, in some instances, the 
fever does not spread from a person who sickens or dies 
at sea, who had carried the seeds of it in his body from 
a sickly shore. It is because no febril miasmata exists in 
the bodies of the rest of the crew to be excited into ac- 
tion by any peculiar smell from the disease, or by fear 
or fatigue, and because no morbid excretions are gene- 
rated by the person who dies. The fever which pre- 
vailed on board the Nottingham East-Indiaman, in the 
year 1766, affected those forty men only, who had slept 
on shore on the Island of Joanna twenty days before. 
Had the whole crew been on shore, the disease would 
probably have affected them all and been ascribed to con- 
tagion generated by the first persons who were confined 
by it,* A Danish ship, in the year 1768, sent twelve 
of her crew on shore for water. They were all seized 
after their return to the ship with a malignant fever, and 
died without infecting any person on board, and from 
the same causes which preserved the crew of the Not- 
tingham East-Indiaman.f 

2. We learn the reason why the disease sometimes 
spreads through a whole ship's crew apparently from one, 
or more affected persons. It is either because they have 

* Observations on the Bilious Fevers usual in voyages to the East- 
Indies, by James Bidenach, M. D. Medical Observations and Inquiries, 
vol. iv. 

f Clarke on the diseases of L*cng Voyages to Hot Climates, p. 123, 12£. 



YELLOW FEVER NOT CONTAGIOUS. 165 

been confined to small and close births by bad weather, 
or because the fever has been protracted to a typhus or 
chronic state, or because the bodies of the whole crew 
are impregnated with morbid miasmata, and thus predis- 
posed to have the disease excited in the manner that has 
been mentioned. In the last way it was excited in most 
of the crew of the United States frigate, in the Dela- 
ware, opposite to the city of Philadelphia, in the year 
1797. It appears to have spread, from a similar cause, 
from a few sailors, on board the Grenville Indiaman, 
after touching at Batavia. The whole crew had been 
predisposed to the disease by inhaling the noxious air of 
that island. 

The same reasons account for the fever expiring in a 
healthy village or country ; also for its spreading when 
carried to those towns which are seated upon creeks or 
rivers, and in the neighbourhood of marsh exhalations. 
It has uniformly perished in the high and healthy village 
of Germantown, when carried from Philadelphia, and 
has three times been supposed, erroneously, to be con- 
tagious near the muddy snores of the creeks which flow 
through Wilmington and Chester. 

3. From the facts that have been mentioned, we are 
taught to disbelieve the possibility of the disease being 
imported in the masts and sails of a ship, by a contagious 
matter secreted by a sailor who may have sickened or 
died on board her, on a passage from a West- India island. 
The death in most of the cases supposed to be imported, 
in this way, occurs within a few days after the ship leaves 
her West-India port, or within a few days after her arri- 
val. In the former case, the disease is derived from 
West-India miasmata ; in the latter, it is derived, as was 
before remarked, either from the foul air of the hold of 
the ship, or of the dock or wharf to which the ship is 
moored. 

Many other facts might be adduced to show the yel- 
low fever not to be an imported disease. It has olten 
prevailed among the Indians remote from the sea coast, 
and many hundred cases of it have occurred since the 
year 1793, on the inland waters of the United States, 
from the Hudson and Susquehannah, to the rivers of the 



166 YELLOW FEVER NOT CONTAGIOUS. 

Mississippi. In South-America, Baron Humboldt assur- 
ed me, it is every where believed to be an endemic of 
that country. 

These simple and connected facts, in which all the 
physicians in the United States who derive the yellow 
fever from domestic causes have agreed, will receive 
fresh support by comparing them with the different and 
contrary opinions of the physicians who maintain its im- 
portation. Some of them have asserted it to be a spe- 
cific disease, and derived it from the East and West- In- 
dies ; others derive it from Beulam, on the coast of 
Africa ; a third sect have called it a ship fever ; a fourth 
have ascribed it to a mixture of imported contagion 
with the foul air of our cities ; while a fifth, who believe 
it to be imported in 1793, have supposed it to be the 
offspring of a contagion left by the disease of that year, 
revived by the heat of our summers, and disseminated, 
ever since, through the different cities of our country. 
The number of these opinions, clearly proves, that no 
one of them is tenable. 

A belief in the non^ contagiousness of the yellow fever, 
or of its being incommunicable except in one of the five 
ways that have been mentioned, is calculated to produce 
the following good effects : 

1. It will deliver the states which have sea-ports from 
four-fifths of the expenses of their present quarantine 
laws and lazarettocs. A very small apparatus, in laws 
and officers, would be sufficient to prevent the landing of 
persons affected by the ship fever in our cities, and the 
more dangerous practice of ships pouring streams of pes- 
tilential air, from their holds, upon the citizens who 
live near the docks and wharves. 

2. It will deliver our merchants from the losses incur- 
red by the delays of their ships, by long and unneces- 
sary quarantines. It will, moreover, tend to procure the 
immediate admission of our ships into foreign ports, by 
removing that belief in the contagious nature of the yel- 
low fever, which originated in our country, and which 
has been spread, by the public acts of our legislatures 
and boards of health, throughout the globe. 



YELLOW FEVER NOT CONTAGIOUS. 167 

3. It will deliver our citizens from the danger to which 
they are exposed, by spending the time of the quarantine, 
on board of vessels in the neighbourhood of the marshes 
which form the shores of the rivers or coasts of quaran- 
tine roads. This danger is much increased by idleness, 
and by the vexation which is excited, by sailors and pas- 
sengers being detained, unnecessarily, fifteen or twenty 
days from their business and friends. 

4. It will lead us to a speedy removal of all the excre- 
tions, and a constant ventilation of the rooms of patients 
in the yellow fever, and thereby to prevent the accumu- 
lation, and further putrefaction of those exhalations which 
may reproduce it. 

5. It is calculated to prevent the desertion of patients 
in the yellow fever, by their friends and families, and to 
produce caution in them to prevent the excitement of the 
disease in their own bodies, by means of low diet and 
gentle physic, proportioned to the impurity of the air, 
and to the anxiety and fatigue to which they are expos- 
sed in attending the sick. 

6. It will put an end to the cruel practice of quieting 
the groundless fears of a whole neighbourhood, by re- 
moving the poor who are affected by the fever, from 
their houses, and conveying them, half dead with dis- 
ease and terror, to a solitary or crowded hospital, or of 
nailing a yellow flag upon the doors of others, or of 
fixing a guard before them, all which have been prac- 
tised in Philadelphia, not only without any good effect, 
but to the great injury of the sick. 

7. By deriving the fever from our own climate and at- 
mosphere, we shall be able to foresee its approach in the 
increased violence of common diseases, in the morbid 
state of vegetation, in the eourse of the winds, in the 
diseases of certain brute animals, and in the increase of 
common, or the appearance of uncommon insects. 

8. A belief in the non-contagiousness of the yellow 
fever, and its general prevalence from putrid animal and 
vegetable matters only, is calculated to lead us to drain 
or cover marshy grounds, and to remove from our cities 
all the sources of impure air, whether they exist in the 



168 YELLOW FEVER NOT CONTAGIOUS. 

holds of ships, in docks, gutters, and common sew- 
ers, or in privies, gardens, yards, and cellars, more 
especially during the existence of the signs of a malignant 
constitution of the air. A fever, the same in its causes, 
and similar to it in many of its symptoms, that is, the 
plague, has been extirpated, by extraordinary degrees of 
cleanliness, from the cities of Holland, Great-Britain, and 
several other parts of Europe. 

The reader will perceive, from these facts and reason- 
ings, that I have relinquished the opinion published in 
my account of the yellow fever in the years 1793, 1794, 
and 1797, respecting its contagious nature. I was mis- 
led by Dr. Lining, and several West-India writers, in 
ascribing a much greater extent to the excreted matters 
in producing the disease, than I have since discovered to 
be correct, and by Bianchi, Lind, Clark, and Cleghorn, 
in admitting even the common bilious fever to be conta- 
gious. The reader will perceive, likewise, that I have 
changed my opinion respecting one of the modes in which 
the plague is propagated. I once believed, upon the 
authorities of travellers, physicians and schools of medi- 
cine, that it was a highly contagious disease. I am now 
convinced this is not the case ; but, from the greater 
number of people who were depressed and debilitated by 
poverty and famine, and who live in small and filthy huts* 
in the cities of the east, than in the cities of the United 
States, I still believe it to be more frequently communi- 
cated from an intercourse with sick people by the mor- 
bid excretions of the body, than the yellow fever is in our 
country. For the change of my opinion upon this sub- 
ject, I am indebted to Dr. Caldwell's and Mr. Webster's 
publications upon pestilential diseases, and to the travels 
of Mariti and Sonnini into Syria, and Egypt. I reject, 
of course, with the contagious quality of the plague, 
the idea of its ever being imported into any country so 
as to become epidemic, by means of a knife-case, a 
piece of cotton, or a bale of silks, with the same decision 
that I do all the improbable and contradictory reports of 
an epidemic yellow fever being imported in a sailor's 

* M. Savary, in his Travels, says, two hundred persons live in Cairo 
within a compass that accomodate but thirty persons in P 



YELLOW FEVER NOT CONTAGIOUS. 169 

jacket, or in the timbers and sails of a ship that had been 
washed by the salt water, and fanned by the pure air of 
the ocean, for several weeks, on her passage from the 
West-Indies to the United States. 

In a former inquiry,* I have taken notice of the metas- 
tasis of error from one medical subject to another. It is 
to be lamented that a similar translation of error has taken 
place from religion to medicine. In the close of the 10th 
century, Pope Gregory excommunicated Robert, king of 
France for marrying his fourth cousin. The king disre- 
garded the edict of the pope, and continued to live with 
his queen. In consequence of his doing so, all his cour- 
tiers and even his domestics deserted him, two of the latter 
only excepted. But such was the dread of these two 
faithful servants, lest they should be infected with the sin 
of their royal master, that they threw all the remains of his 
meals to the dogs, and even purified the vessels in which 
they had been prepared. Let the reader of this fact, who- 
ever he may be, pause and reflect, that if he has at any 
time deserted the sick chamber of a relation, a friend, or a 
neighbour in the plague, or yellow fever, if he has destroy- 
ed the bedding or clothes of a person who has had either 
of those diseases, or if he has approved of a law, which 
has imposed upon a fellow citizen, returning in health 
from a West-India voyage, an offensive fumigation, or a 
tedious quarantine at a sickly lazaretto, in order to destroy 
their supposed contagiousness, let him be assured, what- 
ever his talents and acquirements may be, the folly of the 
domestics of the king of France cleaves to him in another 
form, and will inevitably consign his character with theirs, 
to the pity and ridicule of future generations. 

It gives me pleasure to find the unpopular opinion of 
the non-contagiousness of the plague, which I have adopt- 
ed, is not a new one. It was held by the Faculty of 
Medicine in Paris, in the beginning of the eighteenth 
century, and was ably defended by Dr. Pringle and Dr. 
Pye, about the year 1720 in two very sensible pamphlets 
which' are to be seen in the library of the Pennsylvania 
hospital, written in opposition to Dr. Mead's learned and 
popular tract upon that subject, and which at once terrified 
and misled all the nations of Europe. The same opinion 
* Upon the Gout. 

VOL. IV. T 



170 YELLOW FEVER NOT CONTAGIOUS. 

of the non-contagiousness of the plague has since been 
maintained by Dr. Stoll of Vienna, and Dr. Samoilowitz 
of Russia, and several other eminent physicians. Dr. 
Heberden has lately called in question the truth of all the 
stories that are upon record of the plague having been im- 
ported into England in the last century, and the researches 
of Sir Robert Wilson of the British army, and of Assellini, 
and several other French physicians, have produced the 
most satisfactory proofs of its not being a contagious 
disease in its native country. A discovery more pregnant 
with blessings to mankind has seldom been made. Pyra- 
mids of error, the works of successive ages and nations, 
must fall before it, and rivers of tears must be dried up by 
it. It is impossible fully to appreciate the immense benefits 
which await this mighty achievement of our science upon 
the affairs of the globe. Large cities shall no longer be 
the hot-beds of disease and death. Marshy grounds, 
teeming with pestilential exhalations, shall become the 
healthy abodes of men. A powerful source of repulsion 
between nations shall be removed, and commerce shall 
shake off the fetters which have been imposed upon it 
by expensive and vexatious quarantines. A red or a 
yellow eye shall no longer be the signal to desert a friend 
or a brother to perish alone in a garret or a barn, nor to 
expel the stranger from our houses, to seek an asylum in 
a public hospital, to avoid dying in the street. The num- 
ber of diseases shall be lessened, and the most mortal of 
them shall be struck out of the list of human evils. To 
accelerate these events, it is incumbent upon the physi- 
cians of the United States to second the discoveries of 
their European brethren. It becomes them constantly to 
recollect, that we are the centinels of the health and lives 
of our fellow-citizens, and that there is a grade of benevo- 
lence in our profession much higher than that which arises 
from the cure of diseases. It consists in exterminating 
their causes. 



A DEFENCE 



OF 



BLOOD-LETTING, 



REMEDY FOR CERTAIN DISEASES. 



DEFENCE OF BLOOD-LETTING. 



BLOOD-LETTING, as a remedy for fevers, and 
certain other diseases, having lately been the subject of 
much discussion, and many objections having been made to 
it which appear to be founded in error and fear, I have con- 
sidered that a defence of it, by removing those objections, 
might render it more generally useful, in every part of the 
United States. 

I shall begin this subject by remarking, that blood-let- 
ting is indicated, in fevers of great morbid excitement, 

1. By the sudden suppression or diminution of the 
natural discharges by the pores, bowels, and kidneys, 
whereby a plethora is induced in the system. 

2. By the habits of the persons who are most subject to 
such fevers. 

3. By the phenomena of fever. I have attempted to 
prove that the higher grades of fever depend upon morbid 
and excessive action in the blood-vessels. It is connected 
of course, with preternatural sensibility in their muscular 
fibres. The blood is the most powerful irritant which 
acts upon them. By abstracting a part of it, we lessen 
the principal cause of the fever. The effect of blood- 
letting is as immediate and natural in removing fever, as 
the abstraction of a particle of sand is, to cure an inflam- 
mation of the eye, when it arises from that cause. 

4. By the symptoms of the first stage of violent fevers 
such as a sleepiness and an oppressed pulse, or by delirium, 
with a throbbing pulse, and great pains in every part of 
the body. 

5. By the rupture of the blood-vessels, which takes 
place from the quantity or impetus of the blood in fevers 
of great morbid action. Let no one call bleeding a cruel 
or unnatural remedy. It is one of the specifics of nature; 
but in the use of it she seldom affords much relief. She 



174 



DEFENCE OF BLOOD-LETTING." 



frequently pours the stimulating and oppressing mass of 
blood into the lungs and brain ; and when she finds an 
outlet for it through the nose, it is discharged either in 
such a deficient or excessive quantity, as to be useless or 
hurtful. By artificial blood-letting, we can chuse the 
time and place of drawing blood, and we may regulate its 
quantity by the degrees of action in the blood-vessels. 
The disposition of nature to cure violent morbid action 
by depletion, is further manifested by her substituting, 
in the room of blood-letting, large, but less safe and less 
beneficial, evacuations from the stomach and bowels. 

6. By the structure and use of the spleen. I have call- 
ed it in my lectures upon physiology, a bason furnished 
by nature to hold redundant blood, or to afford it a tem- 
porary asylum, when the blood-vessels are unduly excited. 
Now the spleen is sometimes too small, and often so over- 
charged with blood, or so obstructed, that it cannot per- 
form this olfice, in which case blood-letting is indicated. 
The great enlargement and engorgement of the spleen in 
fatal cases of bilious fevers where sufficient bleeding has 
not been used, prove the truth of this remark. The re- 
life which bleeding gives in chronic and winter intermit- 
tents, is probably occasioned by the spleen being so much 
obstructed, as not to receive the blood in a paroxysm of 
fever. The lancet here performs its vicarious office. 

7. By the relief which is obtained in fevers of violent 
action by remedies of less efficacy (to be mentioned here- 
after), which act indirectly in reducing the force of the 
sanguiferous system. 

8. By the immense advantages which have attended 
the use of blood-letting in violent fevers, when used at a 
proper time, and in a quantity suited to the force of the 
disease. I shall briefly enumerate these advantages. 

1. It frequently strangles a fever, when used in its form- 
ing state, and thereby saves much pain, time, and expense 
to a patient. 

2. It imparts strength to the body, by removing the 
depression which is induced by the remote cause of the 
fever. It moreover obviates a disposition to faint, which 
arises from this state of the system. 

3. It reduces the uncommon frequency of the pulse. 



DEFENCE OF BLOOD-LETTING. 175 

The loss of ten ounces of blood reduced Miss Sally 
Eyre's pulse from 176 strokes to 140, in a few minutes, 
in the fever of the year 1794. Dr. Gordon mentions 
many similar instances of its reducing the frequency of 
the pulse, in the puerperile fever. 

4. It renders the pulse more frequent when it is pre- 
ternaturally slow. 

5. It checks the nausea and vomiting, which attend 
the malignant state of fever. Of this I saw many instan- 
ces in the year 1794. Dr. Poissonnier Desperrieres con- 
firms this remark, in his Account of the Fevers of St. 
Domingo ; and adds further, that it prevents, when suf- 
ficiently copious, the troublesome vomiting which often 
occurs on the fifth day of the yellow fever.* It has the 
same effect in preventing the diarrhoea in the measles. 

6. It renders the bowels, when costive, more easily 
moved by purging physic. 

7. It renders the action of mercury more speedy and 
more certain, in exciting a salivation. 

8. It disposes the body to sweat spontaneously, or ren- 
ders diluting and diaphoretic medicines more effectul for 
that purpose. 

9. It suddenly removes a dryness, and gradually a black- 
ness, from the tongue. Of the former effect of bleeding, 
I saw two instances, and of the latter, one, during the 
autumn of 1794. 

10. It removes or lessens pain in every part of the body, 
and more especially in the head. 

11. It removes or lessens the burning heat of the skin, 
and the burning heat in the stomach, so common and so 
distressing in the yellow fever. 

12. It removes a constant chilliness, which sometimes 
continues for several days, and which will neither yield 
to cordial drinks, nor warm bed clothes. 

13. It checks such sweats as are profuse without af- 
fording relief, and renders such as are partial and moder- 
ate, universal and salutary. 

14. It sometimes checks a diarrhoea and tenesmus 
after astringent medicines have been given to no purpose 
This has often been observed in the measles. 

• Traite de» Fievres de lisle de St Dom * 



176 DEFENCE OF BLOOD-LETTING. 

15. It suddenly cures the intolerance of light which ac- 
companies many of the inflammatory states of fever. 

16. It removes coma. Mr. Henry Clymer was sud- 
denly relieved of this alarming symptom, in the fever of 
1794, by the loss of twelve ounces of blood. 

17. It induces sleep. This effect of bleeding is so 
uniform, that it obtained, in the year 1794, the name of 
an anodyne in several families. Sleep sometimes stole 
upon the patient while the blood was flowing. 

18. It prevents effusions of serum and blood. Hae- 
morrhages seldom occur, where bleeding has been suffi- 
ciently copious. 

19. It belongs to this remedy to prevent the chronic 
diseases of cough, consumption, jaundice, abscess in the 
liver, and all the different states of dropsy which so often 
follow autumnal fevers. 

My amiable friend, Mrs. Lenox, furnished an excep- 
tion to this remark, in the year 1794. After having been 
cured of the yellow fever by seven bleedings, she was af- 
fected, in consequence of taking a ride, with a slight re- 
turn of fever, accompanied by an acute pain in the head, 
and some of the symptoms of a dropsy of the brain. As 
her pulse was tense and quick, I advised repeated bleed- 
ings to remove it. This prescription, for reasons which 
it is unnecessary to relate, was not followed at the time, 
or in the manner, in which it was recommended. The 
pain, in the mean time, became more alarming. In this 
situation, two physicians were proposed by her friends to 
consult with me. I objected to them both, because I 
knew their principles and modes of practice to be contra- 
ry to mine, and that they were proposed only with a view 
of wresting the lancet from my hand. From this desire 
of avoiding a controversy with my brethren, where con- 
viction was impossible on either side, as well as to obviate 
all cause of complaint by my patient's friends, I offered 
to take my leave of her, and to resign her wholly to the 
care of the two gentlemen who were proposed to attend 
her with me. To this she objected in a decided manner. 
But that I might not be suspected of an undue reliance 
upon my own judgment, I proposed to call upon Dr. Grif- 
fitts or Dr. Physick to assist me in my attendance upon 



DEFENCE OF BLOOD-LETTING. 177 

her. Both these physicians had renounced the prejudices 
of the schools in which they had been educated, and had 
conformed their principles and practice to the present 
improving state of medical science. My patient prefered 
Dr. Griffitts, who, in his first visit to her, as soon as he 
felt her pulse, proposed more bleeding. The operation 
was performed by the doctor himself, and repeated daily 
for five days afterwards. From an apprehension that the 
disease was so fixed as to require some aid to blood-letting, 
we gave her calomel in such large doses as to excite a 
salivation. By the use of these remedies she recovered 
slowly, but so perfectly as to enjoy her usual health. 

20. Bleeding prevents the termination of malignant, 
in the gangrenous state of fever. This effect of blood- 
letting will enable us to understand some things in the 
writings of Dr. Morton and Dr. Sydenham, which at first 
sight appear to be unintelligible. Dr. Morton describes 
what he calls a putrid fever, which was epidemic and fatal, 
in the year 1G78. Dr. Sydenham, who practised in Lon- 
don at the same time, takes no notice of this fever. The 
reason of his silence is obvious. By copious bleeding, 
he prevented the fever of that year from running on to 
the gangrenous state, while Dr. Morton, by neglecting to 
bleed, created the supposed putrid fevers which he has 
described. 

It has been common to charge the friends of blood- 
letting with temerity in their practice. From this view 
which has been given of it, it appears, that it would be 
more proper to ascribe timidity to them, for they bleed to 
prevent the offensive and distressing consequences of ne- 
glecting it, which have been mentioned. 

21. It cures, without permitting a fever to put on those 
alarming symptoms, which excite constant apprehensions 
of danger and death, in the minds of patients and their 
friends. It is because these alarming symptoms are pre- 
vented, by bleeding, that patients are sometimes unwilling 
to believe they had been cured by it, of a malignant fever. 
Thus, the Syrian leper of old, viewed the water of Jordan 
as too simple and too common to cure a formidable dis- 
ease, w ithout recollecting that the reme4ies for the greatest 

VOL. IV. 7 



178 DEFENCE OF BLOOD-LETTING. 

evils of life are all simple, and within the power of the 
greatest part of mankind. 

22. It prepares the way for the successful use of the 
bark and other tonic remedies, by destroying, or so far 
weakening, a morbid action in the blood-vessels, that a 
medicine of a moderate stimulus afterwards exceeds it in 
force, and thereby restores equable and healthy action to 
the system. 

23. Bleeding prevents relapses. It, moreover, prevents 
that predisposition to the intermitting and pleuritic states 
of fever, which so frequently attack persons in the spring, 
who have had the bilious remitting fever in the preceding 
autumn. 

But great and numerous as the advantages of blood- 
letting are in fevers, there have been many objections to it. 
I shall briefly enumerate, and endeavour to refute the 
errors upon this subject. 

Blood-letting has been forbidden by physicians, by the 
following circumstances, and states of the system. 

1. By warm weather. Galen bled in a plague, and 
Araeteus in a bilious fever, in a warm climate. Dr. Sy- 
denham and Dr. Hillary inform us, that the most inflam- 
matory fevers occur in, and succeed hot weather. Dr. 
Cleghorn prescribed it copiously in the warm months, in 
Minorca. Dr. Mosely cured the yellow fever by this 
remedy, in Jamaica. Dr. Broadbelt, and Dr. Weston in 
the same island, have lately adopted his successful practice. 
Dr. Desportes speaks in the highest terms of it in all the 
inflammatory diseases of St. Domingo. He complains of 
the neglect of it in the rheumatism, in consequence of 
which, he says, the disease produces abscesses in the 
lungs. Dr. Pugnet says the native physicians of upper 
Egypt bleed in all violent diseases. They are governed 
in their practice by the state of the pulse in the temples, 
and when it does not afford the indication sought for, they 
regulate the use of the lancet by the greater or less red 
colour of the body. I have never, in any year of my 
practice, been restrained by the heat of summer in the use 
of the lancet, where the pulse has indicated it to be neces- 
sary, and have always found the same advantages from it, 
as when I have prescribed it in the winter or spring 
months. 



DEFENCE OF BLOOD-LETTIN C. 179 

In thus deciding in favour of bleeding in warm weather, 
I do not mean to defend its use to the same extent, as to 
diseases, or to quantity, in the native and long settled 
inhabitants of hot climates, as in persons who have recently 
migrated to them, or who live in climates alternately hot 
and cold. 

2. Being born, and having lived in a warm climate. 
This is so far from being an objection to blood-letting in 
an inflammatory disease, that it renders it more necessary. 
I think I have lost several West-India patients from the 
influence of this error. 

3. Great apparent weakness. This, in acute and vio- 
lent fevers, is always from a depressed state of the system. 
It resembles, in so many particulars, that weakness which 
is the effect of the abstraction of stimulus, that it is no 
wonder they have been confounded by physicians. This 
sameness of symptoms from opposite states of the system 
is taken notice of by Hippocrates. He describes convul- 
sions, and particularly a hiccup, as occurring equally from 
repletion and inanition, which answer to the terms of de- 
pression, and debility from action and abstraction. The 
natural remedy for the former is depletion, and no mode 
of depleting is so effectual or safe as blood-letting. But 
the great objection to this remedy is, when a fever of great 
morbid excitement affects persons of delicate constitutions, 
and such as have long been subject to debility of the 
chronic kind. In this state of the system, there is the 
same morbid and preternatural action in the blood-vessels, 
that there is in persons of robust habits, and tke same 
remedy is necessary to subdue it in both cases. It is 
sometimes indicated in a larger quantity in weakly than in 
robust people, by the plethora which is more easily indu- 
ced in their relaxed and yielding blood-vessels, and by 
the greater facility with which ruptures and effusions take 
place in their viscera. Thus it is more necessary to throw 
overboard a large part of the cargo of an old and leaky ves- 
sel in a storm, than of a new and strong one. I know that 
vomits, purges, sweats, and other evacuating remedies, 
are prefered to bleeding in weakly constitutions, but I 
hope to show hereafter, that bleeding is not only more 
effectual, but more safe in such habits, than any other 
depleting remedy. 



180 DEFENCE OF BLOOD-LETTING. 

4. Infancy and childhood. Bleeding is so far from be- 
ing forbidden by these stages of life, that it is called for in 
a greater degree under equal circumstances, than in the 
diseases of adults, by the peculiar excitability of the 
blood-vessels in children, by the difficulty of reducing 
their systems by means of sweats, and in diseases of the 
lungs and trachea, by their inability under two years old, 
to remove the irritation excited by phlegm and mucus in 
those organs, by expectoration. Dr. Sydenham bled 
children in the hooping cough, and in dentition. I bled 
my eldest daughter when she was but six weeks old, for 
convulsions brought on by an excessive dose of laudanum 
given to her by her nurse ; and I bled one of my sons 
twice, before he was two months old, for an acute fever 
which fell upon his lungs and bowels. In both cases, life 
appeared to be saved by this remedy. I could mention 
many more instances in which it has snatched from the 
grave, children under three and four months old, by being 
used from three to five times in the ordinary course of 
their acute diseases. 

5. Old age. The increase of appetite in old people, 
their inability to use sufficient exercise, whereby their 
blood-vessels become relaxed, plethoric, and excitable, and 
above all, the translation of the strength of the muscles to 
arteries, and of plethora to the veins, all indicate bleeding 
to be more necessary (in equal circumstances) in old, than 
in middle aged people. My practice in the diseases' of old 
people has long been regulated by the above facts. I bled 
Mrs. Fullarton twice in a pleurisy in January, 1804, in the 
84th year of her age, and thereby cured her disease. I drew 
six and thirty ounces of blood, in the year 1806, at three 
bleedings, from Mr. Israel Jacobs in the 91st year of his 
age, in a bilious fever, in the course of a few days. He 
was cured by this remedy, and at this time, July 29th 
1809, enjoys good health. I am not the author of this 
bold practise. Botallus left a testimony in favour of it 
nearly 200 years ago.* and it has since been confirmed 
by the experience of Hoffman, and many other physicians. 
An ignorance of, or inattention to this change in the state 

* Magis esse adjuvandossenes, missione sanguinis dum morbus postulat, 
aut corpus eorum habitus malus est, quam ubi hxc (quod absonum vide- 
bitur) juvenibus contingunt. 

De Cur. per Sang, missionem, cap. 11. § 11. 



DEFENCE OF BLOOD-LETTING. 181 

of the blood-vessels, in persons in the decline of life, and 
the neglect of the only remedy indicated by it, is probably 
the reason why diseases often prove fatal to them, which 
in early or middle life cured themselves, or yielded to a 
single dose of physic, or a few ounces of bark. 

6 The time of menstruation. The uterus, during this 
period, is in an inflamed state, and the whole system is 
plethoric and excitable, and of course disposed to a violent 
degree of fever, from all the causes which excite it. Bleed- 
ing, therefore, is more indicated, in fever of great morbid 
action, at this time, dian at any other. Formerly the na- 
tural discharge from the uterus was trusted to, to remove 
a fever contracted during the time of menstruation ; but 
what relief can the discharge of four or five ounces of 
blood from the uterus afford, in a fever which requires the 
loss of 50, or perhaps of 100 ounces to cure it ? 

7. Pregnancy. The inflammation and distention indur 
ced upon the uterus by pregnancy, and the inflammatory 
diathesis thereby imparted to the whole system, render 
bleeding, in the acute states of fever, more necessary than 
at other times. I have elsewhere mentioned the advanta- 
ges of bleeding pregnant women, in the yellow fever. I 
did not learn the advantages of the practice in that disease. 
I bled Mrs. Philler 11 times in seven days, in a pleurisy 
during her pregnancy, in the month of March, 1783. 
Mrs. Fiss was bled 13 times in the spring of 1783 ; and 
Mrs. Kirby 16 times in the same condition, by my orders, 
in the winter of 1786, in a similar disease. All these 
women recovered, and the children they carried during 
their illness, are at this time alive, and in good health. 

8. Fainting after bleeding. This symptom is acciden- 
tal in many people. No inference can be drawn from it 
against blood-letting. It often occurs after the first and 
second bleedings in a fever, but in no subsequent bleed- 
ing, though it be repeated a dozen times. Of this I saw 
several instances, in the yellow fever of 1794. The pulse, 
during the fainting, is often tense and full. 

9. Coldness of the extremities, and of the whole body. 
This cold state of fever when it occurs early, yields more 
readily to bleeding, than to the most cordial medicines. 

10. Sweats are supposed to forbid blood-letting. I 
have seen two instances of death, from leaving a paroxysm 



182 DEFENCE OF BLOOD-LETTING. 

of malignant fever to terminate itself by sweating. Dr. 
Sydenham has taught a contrary practice in the following 
case. " While this constitution (says the doctor) prevail- 
ed, I was called to Dr. Morice, who then practised in 
London. He had this fever, attended with profuse sweats, 
and numerous petechia;. By the consent of some other 
physicians, our joint friends, he was blooded, and rose 
from his bed, his body being first wiped dry. He found 
immediate relief from the use of a cooling diet and medi- 
cines, the dangerous symptoms soon going off; and by con- 
tinuing this method he recovered in a few days."* In 
the same fever, the doctor adds further, " For though one 
might expect great advantages in pursuing an indication 
taken from what generally proves serviceable (viz. sweat- 
ing,) yet I have found, by constant experience, that the 
patient not only finds no relief, but, contrariwise, is more 
heated thereby ; so that frequently a delirium, petechia;, 
and other very dangerous symptoms immediately suc- 
ceed such sweats." \ 

Morgagni describes a malignant fever which prevailed 
in Italy, in which the patients died in profuse sweats, 
while their physicians were looking for a crisis from them. 
Bleeding would probably have checked these sweats, and 
cured the fever. 

11. Dissolved blood, and an absence of an inflamma- 
tory crust on its crassamentum. I shall hereafter place 
dissolved blood at the highest point of a scale, which is 
intended to mark the different degrees of morbid action 
in the system. I have mentioned, in the Outlines of the 
Phenomena of Fever, that it is the effect of a tendency 
to a palsy, induced by the violent force of impression 
upon the blood-vessels, rending and tearing the blood to 
pieces. This appearance of the blood in certain states 
of fever, instead of forbidding bleeding, is the most ve- 
hement call of the system for it. Nor is the absence 
of a crust on the crassementum of the blood, a proof of 
the absence of great morbid diathesis, or a signal to lay 
aside the lancet. On the contrary, I shall show hereafter, 
that there are several appearances of the blood which indi- 

* Wallis's edition, vol. i. p. 210. 
j Vol. i- p. 208. 



DEFENCE OF BLOOD-LETTING. 183 

cate more morbid action in the blood-vessels than a sizy 
or inflammatory crust. 

12. An undue proportion of serum to crassamentum 
in the blood. This predominance of water in the blood 
has often checked sufficient blood-letting. But it should 
be constantly disregarded, while it is attended with those 
states of pulse (to be mentioned hereafter) which require 
bleeding. 

13. The presence of petechia? on the skin. These, I 
have elsewhere said, are the effects of the gangrenous 
state of fever. Dr. Sydenham and Dr. de Haen have 
taught the safety and advantage of bleeding, when 
these spots are accompanied by an active pulse. A boy 
of Mr. John Carrol owes his recovery from the small- 
pox to the loss of fifty ounces of blood, by five bleed- 
ings, at a time when nearly every pock on his arms and 
legs had a purple appearance. Louis XIV. was bled 
five times in the small-pox, when he was but thirteen 
years of age, and thereby probably saved from the grave, 
to the great honour and emolument of the single physi- 
cian who urged it against the advice of all the other phy- 
sicians of the court. Dr. Cleghorn mentions a single 
case of the success of bleeding in the petechial small- 
pox. His want of equal success afterwards, in similar 
cases, was probably occasioned by his bleeding too spar- 
ingly, that is, but three or four times. 

Abscesses and sore breasts, which accompany or suc- 
ceed fever, are no objections to blood-letting, provided 
the pulse indicate the continuance of inflammatory diathe- 
sis. They depend frequently upon the same state of the 
system as livid effusions on the skin 

14. The long duration of fever. Inflammatory diathe- 
sis is often protracted for many weeks, in the chronic 
state of fever. It, moreover, frequently revives after 
having disappeared, from an accidental irritant affecting 
some part of the body, particularly the lungs and brain. 
I bled a young man of James Cameron, in the autumn of 
1794, four times between the 20th and 50th days of a 
chronic fever, in consequence of a pain in the side, ac- 
companied by a tense pulse, which suddenly came on 
after the 20th day of his disease. His blood was sizy. 



184 DEFENCE OF BLOOD-LETTING. 

His pain and tense pulse were subdued by the bleeding 
and he recovered. I bled the late Dr. Prowl twelve times, 
in a fever which continued thirty days, in the autumn of 
the year 1800. I wish these cases to be attended to by 
young practitioners. The pulmonary consumption is 
often the effect of a chronic fever, terminating with fresh 
inflammatory symptoms, by effusions in the lungs. It 
may easily be prevented by forgetting the number of the 
days of our patient's fever, and treating the pulmonary 
affection as if it were a recent complaint. 

15. Tremors and slight convulsions in the limbs. 
Bark, wine, Laudanum, and musk are generally prescrib- 
ed to remove these symptoms ; but, to be effectual, they 
should, in most cases, be preceded by the loss of a few 
ounces of blood. 

16. Bleeding is forbidden after the fifth or seventh 
day in a pleurisy. This prohibition was introduced into 
medicine at a time when a fear was entertained of arresting 
the progress of nature in preparing and expelling morbific 
matter from the system. From repeated experience I 
can assert, that bleeding is safe in every stage of pleurisy 
in which there is pain, and a tense and oppressed pulse ; 
and that it has, when used for the first time after the fifth 
and seventh days, saved many lives. Bleeding has like- 
wise been limited to a certain number of ounces in seve- 
ral states of fever. Were the force of the remote cause 
of a fever, its degrees of violence, and the habits of the 
subject of it, always the same, this rule would be a pro- 
per one ; but, this not being the case, we must be gov- 
erned wholly by the condition of the system, manifested 
chiefly by the state of the pulse. To admit of copious 
bleeding in one state of fever, and not in another, under 
equal circumstances of morbid excitement, is to prescribe 
for its name, and to forget the changes which climate, 
season, and previous habits create in all its different 
states. 

17. The loss of a sufficient quantity of blood is often 
prevented by patients being apparently worse, after the first 
or second bleeding. This change for the worse, shows 
itself in some one or more of the following symptoms, 
viz. increase of heat, chills, delirium, haemorrhages, con- 



DEFENCE OF BLOOD-LETTING. 185 

vulsions, nausea, vomiting, faintncss, coma, great weak- 
ness, pain, a tense, after a soft pulse, and a reduction of 
it in force and frequency They are all occasioned by the 
system rising suddenly from a state of extreme depres- 
sion, in consequence of the abstraction of the pressure 
of the blood to a state of vigour and activity, so great, in 
some instances, as to reproduce a depression below what 
existed in the system before a vein was opened ; or it is 
occasioned by a translation of morbid action from one part 
of the body to another. 

The chills which follow bleeding are the effects of a 
change in the fever, from an uncommon to a common. 
state of malignity. They occur chiefly in those violent 
cases of fever which come on without a chilly fit. 

The haemorrhages produced by bleeding are chiefly 
from the nose, haemorrhoidal vessels, or uterus, and of 
course are, for the most part, safe. 

Uncommon weakness, succeeding blood-letting is the 
effect of sudden depression induced upon the whole sys- 
tem, by the cause before mentioned, or of a sudden 
translation of the excitement of the muscles into the 
blood-vessels, or some other part of the body. These 
symptoms, together with all others which have been men- 
tioned, are so far from forbidding, that they almost forci- 
bly indicate a repetition of blood-letting. 

I shall briefly illustrate, by the recital of three cases, 
the good effects of bleeding, in removing pain, and the 
preternatural slowness and weakness of the pulse, when 
produced by the use of that remedy. 

In the month of June of 1795, 1 visited Dr. Say in a 
malignant fever, attended with pleuritic symptoms, in 
consultation with Dr. Physick. An acute pain in his 
head followed six successive bleedings. After a a seventh 
bleeding, he had no pain. His fever soon afterwards left 
aim. In thus persevering in the use of a remedy, which, 
for several days, appeared to do harm, we were guided 
wholly by the state of his pulse, which uniformly indicat- 
ed, by its force, the necessity of more bleeding. 

In the autumn of 1794, 1 was sent for to visit Samuel 
Bradford, a young man of about 20 years of age, son of 
Mr. Thomas Bradford, who was ill with the reigning 

Vol. iv. a a 



186 DEFENCE OF BLOOD-LETTING. 

malignant epidemic. His pulse was at 80. I drew about 
12 ounces of blood from him. Immediately after his 
arm was tied up, his pulse fell to 60 strokes in a minute. 
I bled him a second time, but more plentifully than be- 
fore, and thereby in a few minutes, brought his pulse 
back again to 80 strokes in a minute. A third bleeding 
the next day aided by the usual purging physic, cured 
him in a few days after. 

In the month of March, 1795, Dr. Physick requested 
me to visit, with him, Mrs. Fries, the wife of Mr. John 
Fries, in a malignant fever. He had bled her four times. 
After the fourth bleeding, her pulse suddenly fell, so as 
scarcely to be perceptible. I found her hands and feet 
cold, and her countenance ghastly, as if she were in the 
last moments of life. In this alarming situation, I sug- 
gested nothing to Dr. Physick but to follow his judgment, 
for I knew that he was master of that law of the animal 
economy which resolved all her symptoms into an oppres- 
sed state of the system. The doctor decided in a moment 
in favour of more bleeding. During the flowing of the 
blood the pulse rose. At the end of three, ten, and seventeen 
hours it fell, and rose again by three successive bleedings, 
in all of which she lost about thirty ounces of sizy blood. 
So great was the vigour acquired by the pulse, a few days 
after the paroxysms of depression, which have been de- 
scribed, were relieved, that it required seven more bleed- 
ings to subdue it. I wish the history of these two cases 
to be carefully attended to by the reader. I have been 
thus minute in the detail of them, chiefly because I have 
heard of practitioners who have lost patients by attempt* 
ing to raise a pulse that had been depressed by bleeding, 
in a malignant fever, by means of cordial medicines, in- 
stead of the repeated use of the lancet. The practice is 
strictly rational ; for, in proportion as the blood-vessels 
are weakened by pressure, the quantity of blood to be 
moved should be proportioned to the diminution of their 
strength. 

This depressed state of the pulse, whether induced by a 
paroxysm of fever, or by blood-letting, is sometimes at- 
tended with a strong pulsation of the arteries in the bow- 
els and head. 



DEFENCE OF BLOOD-LETTING. 187 

1 have mentioned, among the apparent bad effects of 
bleeding, that it sometimes changes a soft into a tense 
pulse. Of this I saw a remarkable instance in Captain 
John Barry, in the autumn of 1795. After the loss of 130 
ounces of blood in a malignant yellow fever, his pulse be- 
came so soft as to indicate no more bleeding. In this 
situation he remained for three days, but without mend- 
ing as rapidly as I expected from the state of his pulse. 
On the fourth day he had a haemorrhage from his bow- 
els, from which he lost above a pint of blood. His pulse 
now suddenly became tense, and continued so for two or 
three days. I ascribed this change in his pulse to the 
vessels of the bowels, which had been oppressed by con- 
gestion, being so much relieved by the haemorrhages, as 
to resume an inflammatory action. I have observed a 
similar change to take place in the pulse, after a third 
bleeding, in a case of hemorrhoidal fever, which came 
under my notice in the month of January, 1803. It is 
thus we see the blood-vessels, in a common phlegmon, 
travel back again, from a tendency to mortification, to the 
red colour and pain of common inflammation. 

From a review of the commotions excited in the sys- 
tem by bleeding, a reason may be given why the physi- 
cians, who do not bleed in the depressed state of the pulse, 
have so few patients in what they call malignant fevers, 
compared with those who use a contrary practice. The 
disease, in such cases, being locked up, is not permitted 
to unfold its true character ; and hence patients are said 
to die of apoplexy, lethargy, cholera, dysentery, or nervous 
fever, who,, under a different treatment, would have ex- 
hibited all the marks of an ordinary malignant fever. 

In obviating the objections to blood-letting from its 
apparent evils, I have said nothing of the apparent bad 
effects of other remedies. A nausea is often rendered 
worse by an emetic, and pains in the bowels are increased 
by a purge. But these remedies notwithstanding main- 
tain, and justly too, a high character among physicians. 

19. Bleeding has been accused of bringing on a ner- 
vous, or the chronic state of fever. The use of this re* 
medy, in a degree so moderate as to obviate the putrid 
or gangrenous state of fever only, may induce the chronic 



^ 



188 DEFENCE OF BLOOD-LETTING. 

state of fever ; for it is the effect, in this case, of the re- 
mains of inflammatory diathesis in the blood-vessels ; but 
but when blood is drawn proportioned to the morbid 
action in the system, it is impossible for a chronic fever 
to be produced by it. Even the excessive use of blood- 
letting, however injurious it may be in other respects, 
cannot produce a chronic fever, for it destroys morbid 
action altogether in the blood-vessels. 

20. Bleeding has been charged with being a weakening 
remedy. I grant that it is so, and in this, its merit chiefly 
consists. The excessive morbid action of the blood-ves- 
sels must be subdued in part in a fever, before stimulating 
remedies can be given with safety or advantage. Now 
this is usually attempted by depleting medicines, to be 
mentioned hereafter, or it is left to time and nature, all of 
which are frequently either deficient, or excessive in their 
operations ; whereas bleeding, by suddenly reducing the 
morbid action of the blood-vessels to a wished-for point 
of debility, saves a great and unnecessary waste of exci- 
tability, and thus prepares the body for the exhibition of 
such cordial remedies as are proper to remove the debility 
which predisposed to the fever. 

21. It has been said that bleeding renders the habitual 
use of it necessary to health and life. This objection to 
blood-letting is founded upon an ignorance of the differ- 
ence between the healthy, and morbid action of the blood- 
vessels. Where blood is drawn in health, such a relax- 
ation is induced in the blood-vessels, as to favour the 
formation of plethora, which may require habitual bleed- 
ing to remove it ; but where blood is drawn only in the 
inflammatory state of fever, the blood-vessels are reduced 
from a morbid degree of strength to that which is natural, 
in which state no predisposition to plethora is created, 
and no foundation laid for periodical blood-letting. But 
there are cases which require even this evil, to prevent a 
greater. Thus we cure a strangulated hernia, when no 
fever attends, by the most profuse bleeding. The ple- 
thora and predisposition to disease which follow it are 
trifling, compared with preventing certain and sudden 
death. 

22. Bleeding has been accused of bringing on an in- 



DEFENCE OF BLOOD-LETTING. 189 

terrnitting fever. This is so far from being an objection 
to it, that it should be considered as a new argument in 
its favour ; for when it produces that state of fever, it con- 
verts a latent, and perhaps a dangerous disease, into one 
that is obvious to the senses, and under the dominion of 
medicine. Nor is it an objection to blood-letting, that, 
when used in an inflammatory intermittent, it sometimes 
changes it into a continual fever. An instance of the good 
effects of this change occurred in the Pennsylvania hos- 
pital, in an obstinate tertian, in the year 1804. The con- 
tinual fever, which followed the loss of blood, was cured 
in a few days, and by the most simple remedies. 

23 It has been said that bleeding, more especially 
where it is copious, predisposes to effusions of serum in 
the lungs, chest, bowels, limbs, and brain. In replying 
to this objection to bleeding, in my public lectures, I have 
addressed my pupils in the following language : " Ask 
the poor patients who come panting to the door of our 
hospital, with swelled legs and hard bellies, every fall, 
Whether they have been too copiously bled, and they will 
all tell you, that no lancet has come near their arms. Ask 
the parents who still mourn the loss of children who have 
died, in our city, of the internal dropsy of the brain, whe- 
ther they were destroyed by excessive blood-letting ? If 
the remembrance of the acute sufferings which accompa- 
nied their sickness and death will permit these parents 
to speak, they will tell you, that every medicine, ex- 
cept bleeding, had been tried to no purpose in their 
children's diseases. Go to those families in which I 
have practised for many years, and inquire, whether 
there is a living or a dead instance of dropsy having fol- 
lowed, in any one of them, the use of my lancet? Let 
the undertakers and grave-diggers bear witness against 
me, if I have ever, in the course of my practice, convey- 
ed the body of a single dropsical patient into their hands, 
by excessive blood-letting? No. Dropsies, like abscess- 
es and gangrenous eruptions on the skin, arise, in most 
cases, from the want of sufficient bleeding in inflammatory 
diseases. Debility, whether induced by action or ab- 
straction, seldom disposes to effusion. Who ever heard 



190 DEFENCE OP BLOOD-LETTING. 

of dropsy succeeding famine ? And how rarely do we 
see it accompany the extreme debility of old age ?" 

11 If ever bleeding kills," says Bottallus, either directly 
or indirectly, through the instrumentality of other diseases, 
" it is not from its excess, but because it is not drawn in 
a sufficient quantity, or at a proper time.*" And, again, 
says this excellent writer, " One hundred thousand men 
perish from the want of blood-letting, or from its being 
used out of time, to one who perishes from too much 
bleeding, prescribed by a physician.f" 

It is remarkable, that the dread of producing a dropsy 
by bleeding, is confined chiefly to its use in malignant 
fevers ; for the men who urge this objection to it, do not 
hesitate to draw four or five quarts of blood in the cure 
of the pleurisy. The habitual association of the lancet 
with this disease, has often caused me to rejoice when I 
heard a patient complain of a pain in his side, in a malig- 
nant fever. It insured to me his consent to the frequent 
use of the lancet, and it protected me, when it was used 
unsuccessfully, from the clamours of the public, for few 
people censure copious bleeding in a pleurisy. 

24. Against blood-letting it has been urged, that the 
Indians of our country cure their inflammatory fevers 
without it. To relieve myself from the distressing ob- 
loquy to which my use of this remedy formerly exposed 
jne, I have carefully sought for, and examined their re- 
medies for those fevers, with a sincere desire to adopt 
them; but my inquiries have convinced me, that they 
are not only disproportioned to the habits and diseases of 
civilized life, but that they are far less successful than 
blood-letting, in curing the inflammatory fevers which oc- 
cur among the Indians themselves. 

25. Evacuating remedies of another kind have been 
said to be more safe than bleeding, and equally effectual, 
in reducing the inflammatory state of fever. I shall enu- 
merate each of these evacuating remedies, and then draw 
a comparative view of their effects with blood-letting. 
They are, 

I. Vomits. 

* Cap. viii. § 4. + Cap. xxxvi. § 4. 



DEFENCE OF BLOOD-LETTING. 191 

II. Purges. 

III. Sweats. 

IV. Salivation. And, 

V. Blisters. 

I. Vomits have often been effectual in curing fevers 
of a mild character. They discharge offensive and irri- 
tating matters from the stomach ; they lessen the fulness 
of the blood-vessels, by determining the serum of the 
blood through the pores ; and they equalize the excite- 
ment of the system, by inviting its excessive degrees from 
the blood-vessels to the stomach and muscles. But they 
are, 

1. Uncertain in their operation, from the torpor induced 
by the fever upon the stomach. 

2. They are unsafe in many conditions of the system, 
as in pregnancy, and a disposition to apoplexy and rup- 
tures. Life has sometimes been destroyed by their in- 
ducing cramp, haemorrhage, and inflammation in the 
stomach. 

3. They are not subject to the controul of a physician, 
often operating more, or less than was intended by him, 
or indicated by the disease. 

4. They are often ineffectual in mild, and always so in 
fevers of great morbid action. 

II. Purges are useful in discharging acrid feces and 
bile from the bowels in fevers. They act, moreover, by 
creating an artificial weak part, and thus invite morbid 
excitement from the blood-vessels to the bowels. They 
likewise lessen the quantity of blood, by preventing fresh 
accessions of chyle being added to it ; but like vomits 
they are, 

1. Uncertain in their operation ; and from the same 
cause. Many ounces of salts and castor oil, and whole 
drachms of calomel and jalap, have often been given, with- 
out effect, to remove the costiveness which is connected 
with the malignant state of fever. 

2. They are not subject to the direction of a physician, 
with respect to the time of their operation, or the quanti- 
ty or quality of matter they are intended to discharge 
from the bowels. 



192 DEFENCE OF BLOOD-LETTING. 

3. They are unsafe in the advanced stage of fevers. 
Dr. Physick informed me, that three patients died in the 
water-closet, under the operation of purges, in St. George's 
hospital, during his attendance upon it. I have seen 
death, in several instances, succeed a plentiful spontane- 
ous stool in debilitated habits. 

III. Sweating was introduced into practice at a time 
when morbific matter was supposed to be the proximate 
cause of fever. It acts, not by expelling any thing ex- 
clusively morbid from the blood, but by abstracting a 
portion of its fluid parts, and thus reducing the action of 
the blood-vessels. This mode of curing fever is still 
fashionable in genteel life. It excites no fear, and offends 
no sense. The sweating remedies have been numerous, 
and fashion has reigned as much among them, as in other 
things. Alexipharmic waters, and powders, and all the 
train of sudorific medicines, have lately yielded to the 
different preparations of antimony, particularly to James's 
powder. I object to them all, 

1. Because they are uncertain ; large and repeated 
doses of them being often given to no purpose. 

2. Because they are slow and disagreeable, where they 
succeed in curing fever. 

3. Because, like vomits and purges, they are not under 
the direction of a physician, with respect to the quantity 
of fluid discharged by them. 

4. Because they are sometimes, even when most pro- 
fuse, ineffectual in the cure of fever. 

5. The preparations of antimony, lately employed for 
the purpose of exciting sweats, are by no means safe. 
They sometimes convulse the system by a violent puk- 
ing. Even the boasted James's powder has done great 
mischief. Dr. Goldsmith and Mr. Howard, it is said, 
were destroyed by it. 

None of these objections to sweating remedies are in- 
tended to dissuade from their use, when nature shows a 
disposition to throw off a fever by the pores of the skin; 
but, even then, they often require the aid of bleeding to 
render them effectual for that purpose. 

IV. Mercury, the Sampson of the materia medica, after 
having subdued the venereal disease, the tetanus, and 



DEFENCE OF BLOOD-LETTING. 193 

many other formidable diseases, has lately added to its 
triumphs and reputation, by overcoming the inflammatory 
and malignant state of fever. I shall confine myself, in 
this place, to its depleting operation, when it acts by ex- 
citing a salivation. From half a pound to two pounds of 
fluid are discharged by it in a day. The depletion in this 
way is gradual, whereby fainting is prevented. By ex- 
citing and inflaming the glands of the mouth and throat, 
excitement and inflammation are abstracted from more 
vital parts. In morbid congestion and excitement in the 
brain, a salivation is of eminent service, from the prox- 
imity of the discharge to the part affected. But I object 
to it, as an exclusive vacuant in the cure of fever, 

1. Because it is sometimes impossible, by the largest 
doses of mercury, to excite it, when the exigences of the 
system render it most necessary. 

2. Because it is not so quick in its operation, as to be 
proportioned to the rapid progress of the malignant state 
of fever. 

3. Because it is at all times ^disagreeable, and fre- 
quently a painful remedy, more especially where the teeth 
are decayed. 

4. Because it cannot be proportioned in its duration, 
or in the quantity of fluid discharged by it, to the violence 
or changes in the fever. 

Dr Chisholm relied, for the cure of the Beullam fever 
at Grenada, chiefly upon this evacuation. I have men- 
tioned the ratio of success which attended it. 

V. Blisters are useful in depleting from those parts 
which are the seats of topical inflammation. The re- 
lief obtained by them in this way more than balances 
their stimulus upon the whole system. I need hardly 
say, that their effects in reducing the morbid and exces- 
sive action of the blood-vessels are very feeble. To de- 
pend upon them in cases of great inflammatory action, is 
as unwise as it would be to attempt to bale the water from 
a leaky and sinking ship by the hollow of the hand, in- 
stead of discharging it by two or three pumps. 

VI. Abstemious diet has sometimes been prescriflfed 
as a remedy for fever. It acts directly by the abstraction 
of the stimulus of food from the stomach, and indirectly 

vol. iv. B b 



194 DEFENCE OF BLOOD-LETTING. 

by lessening the quantity of blood. It can bear no pro- 
portion, in its effects, to the rapidity and violence of an 
inflammatory fever. In chronic fever, such as occurs in 
the pulmonary consumption, it has often been tried to no 
purpose. Long before it reduces the pulse, it often in- 
duces such a relaxation of the tone of the stomach and 
bowels as to accelerate death. To depend upon it there- 
fore in the cure of inflammatory fever, whether acute or 
chronic, is like trusting to the rays of the sun to exhale 
the water of an overflowing tide, instead of draining it off 
immediately, by digging a hole in the ground. But there 
are cases in which the blood-vessels become so insolated, 
that they refuse to yield their morbid excitement to de- 
pletion from any outlet, except from themselves. I at- 
tended a sailor, in the Pennsylvania hospital, in 1799, who 
was affected with deafness, attended with a full and tense 
pulse. I prescribed for it, purging, blisters, and low diet, 
but without any effect. Perceiving no change in his 
pulse, nor in his disease, from those remedies, I ordered 
him to lose ten ounce^bf blood. The relief obtained by 
this evacuation induced me to repeat it. By means of six 
bleedings he was perfectly cured, without the aid of any 
other remedy. 

Bleeding has great advantages over every mode of de- 
pleting that has been mentioned. 

1. It abstracts one of the exciting causes, viz. the stim- 
ulus of the blood from the seat of fever. I have formerly 
illustrated this advantage of blood-letting, by comparing 
it to the abstraction of a grain of sand from the eye to 
cure an opthalmia. The other depleting remedies are as 
indirect and circuitous in their operation in curing fever, 
as vomits and purges would be to remove an inflamma- 
tion in the eye, while the grain of sand continued to irri- 
tate it. 

2. Blood-letting is quick in its operation, and may be 
accommodated to the rapidity of fever, when it manifests 
itself in apoplexy, palsy, and syncope. 

It is under the command of a physician. He may 
bMed when and where he pleases, and may suit the quan- 
tity of blood he draws, exactly to the condition of his 
patient's system. 



DEFENCE OF BLOOD-LETTING. 195 

4. It may be performed with the least attendance of 
nurses or friends. This is of great importance to the poor 
at all times, and to the rich during the prevalence of mor- 
tal epidemics. 

5. It disturbs the system much less than any of the 
other modes of depleting, and therefore is best accommo* 
dated to that state of the system, in which patients are in 
danger of fainting or dying upon being moved. 

6. It is a more delicate depleting remedy than most of 
those which have been mentioned, particularly vomits, 
purges, and a salivation. 

7. There is no immediate danger to life from its use. 
Patients have sometimes died under the operation of vo- 
mits and purges, but I never saw nor heard an instance 
of a patient's dying in a fainty fit, brought on by bleed- 
ing. 

8. It is less weakening, when used to the extent that 
is necessary to cure, than the same degrees of vomiting, 
purging, and sweating. 

9. Convalescence is more rapid and more perfect after 
bleeding, than after the successful use of any of the other 
evacuating remedies. 

By making use of blood-letting in fevers, we are not 
precluded from the benefits of the other evacuating re- 
medies. Some of them are rendered more certain and 
more effectual by it, and there are cases of fever, in which 
the combined or successive application of them all is 
barely sufficient to save life. 

To rely upon any one evacuating remedy, to the ex- 
clusion of the others, is like trusting to a pair of oars in a 
sea voyage, instead of spreading every sail of a ship. 

I suspect the disputes about the eligibility of the dif- 
ferent remedies which have been mentioned, have arisen 
from an ignorance that they belong to one class, and that 
they differ only in their force and manner of operation. 
Thus the physicians of the last century ascribed different 
virtues to salts of different names, which the chemists of 
the present day have taught us are exactly the same, and 
differ only in the manner of their being prepared. 

Having replied to the principal objections to blood-let- 
ting, and stated its comparative advantages over other 



196 DEFENCE OF BLOOD-LETTlNC. 

modes of depletion, I proceed next to mention the cir- 
cumstances which should regulate the use of it. These 
are, 

I. The state of the pulse. 

The following states of the pulse indicate the necessity 
of bleeding. 

1. A full, frequent and vigorous pulse without tension, 
such as occurs in the yellow fever, gout and apoplexy. I 
have called it the synochus fortis pulse. 

2. A full, frequent, and tense pulse, such as occurs in 
the pulmonary, rheumatic, gouty, phrenitic, and maniacal 
states of fever. 

3. A full, frequent, and jerking pulse, without tension, 
such as frequently occurs in the vertiginous, paralytic, 
apoplectic, and hydropic states of fever. 

4. A small, frequent, but tense pulse, such as occurs in 
the chronic pulmonary, and rheumatic states of fever. 

5. A tense and quick pulse, without much preternatu- 
ral frequency. This state of the pulse is common in the 
yellow fever. 

6. A slow and tense pulse, such as occurs in the apo- 
plectic, hydrocephalic, and malignant states of fever, in 
which its strokes are from 60 to 9, in a minute. 

7. An uncommonly frequent pulse, without much ten- 
sion, beating from 120 to 170 or 180 strokes in a minute. 

This state of the pulse occurs likewise in the malignant 
states of fever, 

8. A soft pulse, without much frequency or fulness. I 
have met with this state of the pulse in affections of the 
brain, and in that state of pulmonary fever which is known 
by the name of pneumonia notha. It sometimes, I have re- 
marked, becomes tense after bleeding. 

9. An intermitting pulse. 

10. A depressed pulse. 

11. An imperceptible pulse. The slow, intermitting, 
depressed, and imperceptible states of the pulse are sup- 
posed exclusively to indicate congestion in the brain. But 
they are all, I believe, occasioned likewise by great excess 
of stimulus acting upon the heart and arteries. A pulse 
more tense in one arm than in the other, I have generally 
found to attend a morbid state of the brain. Much vet 
remains to be known of the signs of a disease in the 



DEFENCE OF BL00D-L2TTINC 197 

brain, by the states of the pulse ; hence Mr. Hunter has 
justly remarked, that " In inflammation of the brain, the 
pulse varies more than in inflammations of any other part ; 
and perhaps we are led to judge of inflammation there, 
more from other symptoms than the pulse."* 

The slow, uncommonly frequent, intermitting, and im- 
perceptible states of the pulse, which require bleeding, 
may be distinguished from the same states of the pulse, 
which arise from an exhausted state of the system, and 
that forbid bleeding, by the following marks : 

1. They occur in the beginning of a fever. 

2. They occur in the paroxysms of fevers which have 
remissions and exacerbations. 

3. They sometimes occur after blood-letting, from 
causes formerly mentioned. 

4. They sometimes occur, and continue during the 
whole course of an inflammation of the stomach and bow- 
els. And, 

5. They occur in relapses, after the crisis of a fever. 
The other stages of the pulse indicate bleeding in every 

stage of fever, and in every condition of the system. 1 have- 
taken notice, in another place, of the circumstances which 
render it proper in the advanced stage of chronic fever. 

If all the states of pulse which have been enumerated 
indicate bleeding, it must be an affecting consideration to 
reflect, how many lives have been lost, by physicians limit- 
ing the use of the lancet only to the tense or full pulse ! 

I wish it comported with the proposed limits of this 
essay to illustrate and establish, by the recital of cases, the 
truth of these remarks, upon the indications of bleeding 
from the pulse. It communicates much more knowledge 
of the state of the system than any other sign of disease. 
Its frequency (unconnected with its other states,) being un- 
der the influence of diet, motion, and the passions of the 
mind, is of the least consequence. In counting the num- 
ber of its strokes, we are apt to be diverted from attending 
to its irregularity and force ; and in these, it should always 
be remembered, fever chiefly consists. The knowledge 
acquired by attending to these states of the pulse is so 
definite and useful, and the circumstances which seduce 
from a due attention to them are so erroneous in their in- 
dications, that I have sometimes wished the Chinese cus- 
* Treatise on Inflammation, chap. iii. 9. 



198 DEFENCE OF BLOOD-LETTING. 

ton of prescribing, from feeling the pulse only, without 
seeing or conversing with the patient, were imposed upon 
all physicians. 

To render the knowledge of the indications of blood- 
letting, from the state of the pulse, as definite and correct 
as possible, I shall add, for the benefit of young practi- 
tioners, the following directions for feeling it. 

1. Let the arm be placed in a situation in which all the 
muscles which move it shall be completely relaxed ; and 
let it, at the same time, be free from the pressure of the 
body upon it. 

2. Feel the pulse, in all obscure or difficult cases, in 
both arms. 

3. Apply all the fingers of one hand, when practicable, 
to the pulse. For this purpose, it will be most conve- 
nient to feel the pulse of the right hand with your left, and 
of the left hand with your right. 

4. Do not decide upon blood-letting, in difficult cases, 
until you have felt the pulse for some time. The Chi- 
nese physicians never prescribe until they have counted 
49 strokes. 

5. Feel the pulse at the intervals of four or five min- 
utes, when you suspect that its force has been varied by 
any circumstances not connected with the disease, such 
as emotions of the mind, exercise, eating, drinking, and 
the like. 

6. Feel the pulsations of the arteries in the temples and 
in the neck, when the pulse is depressed or imperceptible 
in the wrists. 

7. Request silence in a sick room, and close your eyes, 
in feeling a pulse in difficult cases. By so doing, you will 
concentrate the sensations of your ears and eyes, in your 
fingers. 

In judging of the states of the pulse which have been 
enumerated, it will be necessary always to remember the 
natural difference, in its frequency and force, in old people 
and children ; also in the morning and evening, and in the 
sleeping and waking states of the system. 

Much yet remains to be known upon this subject. I 
have mentioned the different states of the pulse which call 
for bleeding, but it is more difficult to know when to pre- 
scribe it, when the pulse imparts no signs of disease. In 



DEFENCE OF BLOOD-LETTING. 199 

general it may be remarked when the disease is recent> 
the part affected important to life, and incapable of sus- 
taining violent morbid action long, without danger of 
disorganization, where pain is great, and respiration diffi- 
cult, where there is redness in the face, and a watery, 
lively, or suffused eye, the pulse may be disregarded in 
the use of the lancet. To these signs, Dr. Sydenham 
adds, in the history of the case of a lady in whom the 
pulse gave no indication of the force of the disease, 
" a red colour in the cheeks ; drops of blood issuing from 
the nose, no diminution of the heat of the body after 
bleeding and the existence of an inflammatory constitu- 
tion of the atmosphere."* 
But to return. 

II. Regard should be had to the character of the reign- 
ing epidemic, in deciding upon blood-letting. If the 
prevailing fever be of a highly inflammatory nature, bleed- 
ing may be used with more safety, in cases where the 
indications of it from the pulse are somewhat doubtful. 
The character of a previous epidemic should likewise di- 
rect the use of the lancet. The pestilential fever which 
followed the plague in London, in 1665. Dr. Sydenham 
says, yielded only to blood-letting. It is equally neces- 
sary in all the febrile diseases which succeed malignant 
fevers. 

III. Regard should be had to the season of the year, 
and to the state of the weather. It is more copiously in- 
dicated in the winter and spring, than in summer and 
autumn in middle latitudes, and Dr. Hillary and Dr. 
Huxham both say, it is more necessary in dry, than in 
moist weather. 

The words of Dr. Huxham upon this subject are as 
follow, " Diseases even of the same species (as I have 
constantly observed) require much larger bleeding, and 
the sick bear it much better in dry weather, when the 
barometer stands high, than when a hot moist air almost 
destroys the tone of the vessels. This is constantly ob- 
servable even in diseases of the brcast.f" The advan- 

* Wallis's edition, vol. i. 134. 

f Observations upon the air, and Epidemic Diseases, preface page 
xxviii. 



200 DEFENCE OF BLOOD-LETTING. 

tages of copious bleeding in the yellow fever of 1793, 
when the weather was uncommonly dry, confirms the 
truth of the remarks of those excellent practical physi- 
cians. 

IV. The constitution of a patient, and more especially 
his habits with respect to blood-letting, should be taken 
into consideration, in prescribing it. If he be plethoric, 
and accustomed to bleeding in former indispositions, it 
will be more necessary, than in opposite states and habits 
of the system. Nature will expect it. 

V. The corpulency of a patient should regulate the use 
of the lancet. A butcher of great observation informed 
me, that a fat ox did not yield more than from one half, 
to one third of the quantity of blood of a lean one, of the 
same size of bone, and it is well known that the loss of 
a small quantity of blood, after cutting off the head of a 
fowl, is always a sign of its being fit for the table. The 
pressure of fat upon the blood-vessels produces the same 
effects in the human species that it does in those animals ; 
of course, less blood should be drawn from fat, than from 
lean people, under equal circumstances of disease. 

VI. As persons have more or less blood in their ves- 
sels, according to their size, less blood should be drawn, 
under equal circumstances, from small than large people. 

VII. Regard should be had to the age of adults in pre- 
scribing bleeding. In persons between fifty and sixty years 
of age, for reasons formerly mentioned, more blood may 
be drawn than in middle life, in similar diseases. In 
persons beyond 70, it will be necessary to regulate the 
quantity to be drawn by other signs than the pulse, or the 
appearances of the blood, the former being generally full, 
and sometimes tense, and the latter often putting on the 
sign of the second grade of morbid action formerly des 
cribed. 

VIII. Regard should be had to the country or place 
from which persons affected with fevers have arrived, 
in prescribing the loss of blood. Fevers, in America, 
are more inflammatory than fevers, in persons of equal 
rank, in Great-Britain. A French physician once said, 
it was safer to draw a hogshead of wine from a French- 
man's veins, than a quarter of a hundred pounds of beef 



DEFENCE OF BLOOD-LETTING. 201 

from an Englishman's, meaning to convey an idea of the 
difference in the grades of morbid or inflammatory action 
in the diseases of the inhabitants of France and England, 
and of the difference in the quantity of blood proper to be 
drawn m each of them. A similar difference exists between 
the grades of fever in Great-Britain and America. From 
a want of attention to this circumstance, I saw a common 
pleurisy end in an abscess of the lungs, in a sea captain, 
in the city of London, in the year 1769, who was attend- 
ed by a physician of the first reputation in England. He 
was bled but once. His pulse and American constitution 
called for the loss of 50 or 60 ounces of blood. My for- 
mer pupil Dr. Fisher in a letter from the university of 
Edinburgh dated in the winter of 1795, informed me, 
that he had cured several of his American fellow students 
of fevers, contrary to the general prejudices and practice 
m that city, by early bleeding, m as easy and summary a 
way as he had been accustomed to see them cured in Phila- 
delphia by the same remedy. It is not less true, and wor- 
thy of the attention of an American physician, that the 
diseases of new comers into the United States from Great- 
Britain, Ireland and other European countries, require 
more bleeding than the natives or old settlers, under equal 
circumstances of disease. This fact struck the late Dr. 
Reynolds in a very forcible manner, in his extensive prac- 
tice among his newly arrived fellow citizens from Ireland. 
The remark is founded in reason, and it is to be wished, 
those European physicians who charge their patients when 
they are about to emigrate to America, " never to be 
bled," would consider how much the change which the 
stimulating impressions of a new climate, diet, com- 
pany, and often of employments, make upon the system, 
is opposed to their advice. 

IX. Regard should be had to the structure and situa- 
tion of the parts diseased with febrile action. The brain, 
from its importance, to all the functions of life, the rectum 
the bladder, and the trachea, when inflamed, and the in- 
testines, when strangulated, from their being removed so 
much out of the influence of the great circulation, all re- 
quire more copious bleeding than the same degrees of 
disease in the lungs, and some other parts of the body. 

vol. iv. c c 



202 DEFENCE OF BLOOD-LETTING. 

X. After blood-letting has been performed, the appear* 
ances of the blood should be attended to, in order to judge 
of the propriety of repeating it. I shall briefly describe 
these appearances, and arrange them in the order in which 
they indicate the different degrees of inflammatory dia- 
thesis, beginning with the highest. 

1. Dissolved blood. It occurs in the malignant states 
of fever. I have seen it several times in the pleurisy, and 
have once heard of it in a case of gout. I have ascribed 
this decomposition of the blood to such a violent, or fee- 
ble degree of action in the blood-vessels as to dispose 
them to a paralytic state. It is generally considered as a 
signal to lay aside the lancet. If it occur in thtjirst stage 
of a fever, it indicates a very opposite practice. By re- 
peated bleedings, the vessels recover their natural action, 
and the blood becomes resuscitated, or reduced to its 
original texture. Of tlV 1 have had frequent experience, 
since the year 1793. It required three successive bleed- 
ings to restore the blood from a dissolved, to a coagula- 
ble state, in Mr. Benton. It afterwards became very 
sizy. If this dissolved blood appear towards the close 
of a malignant fever, no other benefit than the protraction 
of life for a day or two, or an easy death, can be expected 
from repeating the bleeding, even though it be indicated 
by a tense pulse ; for the viscera are generally so much 
choaked by the continuance of violent action in the blood- 
vessels, that they are seldom able to discharge the blood 
which distends them, into the cavity in the vessels, which 
is created by the abstraction of blood from a vein. There 
is some variety in the appearance of this state of the blood, 
which indicates more or less violent pressure upon the 
blood-vessels. It threatens most danger to life when it 
resembles molasses in its consistence. The danger is less 
when the part which is dissolved occupies the bottom of 
the bowl, and when its surface is covered with a sizy 
pellicle or coat. I have said the blood is sometimes dis- 
solved from a too feeble action of the blood-vessels upon 
it. We observe this in the scurvy and in the lowest grade 
of typhus fever. It is restored in these cases to its natural 
consistence by means of stimulating remedies. To this 
account of the morbid state of the blood, it may not be 
improper to add, that Dr. Stoll found it coagulated in the 



DEFENCE OF B LOOD-LETTINC: 203 

veins of an epileptic patient, and that Morgagni mentions 
the case of a girl in whom the blood was cold. She had 
at the same time no sense of coldness in any part of her 
body. By means of stimulants, she was recovered. 

Does not the restoration of the blood from its disor- 
ganized state, by means of bleeding, suggest an idea of 
a similar change being practicable in the solids, when they 
are disorganized by disease? And are we not led here- 
by to an animating view of the extent and power of me- 
dicine ? 

2. Blood of a scarlet colour, without any separation 
into crassamentum or serum, indicates a second degree of 
morbid action. It occurs likewise in the malignant state 
of fever. It is called improperly dense blood. It occurs 
in old people. 

3. Blood in which part of the crassamentum is dissolv- 
ed in the serum, forming a resemblance to what is called 
the lotura carnium, or the washings of flesh in water. 

4. Serum of a clear red, or green colour. The vio- 
lence and danger of fevers in which the serum of the blood 
assumes the latter colour, is taken notice of by Dr. Hux- 
ham.* 

5. Crassamentum sinking to the bottom of a bowl in 
yellow serum. 

6. Crassamentum floating in serum, which is at first 
turbid, but which afterwards becomes yellow and trans- 
parent, by depositing certain red and fiery particles of the 
blood in the bottom of the bowl. 

7. Sizy blood, or blood covered with a buffy coat. The 
more the crassamentum appears in the form of a cup, the 
more inflammatory action is said to be indicated by it. 
This appearance of the blood occurs in all the common 
states of inflammatory fever. It occurs too in the mild 
state of malignant fevers, and in the close of such of them 
as have been violent. It is not always confined to the 
common inflammatory state of the pulse, for I have ob- 
served it occasionally in most of the different states of the 
pulse which have been described. The appearance of 
this huffy coat on the blood in the yellow fever is always 
favourable. It shows the disease to be tending from an 

• On Air and Epidemics, vol. i. p.. 129. 



204 DEFENCE OF BLOOD-LETTING. 

uncommon to a common degree of inflammatory diathe- 
sis. It has been remarked, that blood which resembles 
claret in its colour, while flowing, generally puts on, 
when it cools, a sizy appearance. Blood which assumes 
a paler red colour near the edges of the bowl, than that 
which is in the middle of the bowl into which it is flow- 
ing, is likewise generally sizy. 

It would seem, from these facts, that the power of co- 
agulation in the blood was lessened in an exact ratio to 
the increase of action upon the blood-vessels, and that it 
was increased in proportion to the diminution of that ac- 
tion, to that degree of it which constitutes w hat I have 
called common inflammatory action. 

Here, as upon a former occasion, we may say with 
concern, if bleeding be indicated by all the appearances 
of the blood which have been enumerated, how many 
lives have beem lost by physicians limiting the use of the 
lancet to those cases only, where the blood discovered an 
inflammatory crust ! 

It would be a digression from the subject now under 
consideration, or I would add in this place some remarks 
upon what is called the vitality of the blood. I shall only 
mention, that I have for many years taught in my physio- 
logical lectures that the blood in the healthy state appears 
to be like the bones and tendons, ammahzed only, and 
that like those parts of the body, it becomes animated 
by the stimulus of disease. The more sizy it becomes, 
the more it partakes of an animated quality. Its cupped 
appearance indicates its having assumed a muscular na- 
ture. It is in this animated state of the fibrin only, that 
it forms those membranes which succeed inflammation 
in different parts of the body. 

The remarks which have been delivered upon the rela- 
tive signs of inflammatory action in the blood-vessels, 
should be admitted with a recollection that they are all 
liable to be varied by a moderate, or violent exacerbation 
of fever, by the size of the stream of blood, and by the 
heat, coldness, and form of the cup into which the blood 
flows. Even blood drawn, under exactly equal circum- 
stances, from both arms, exhibited, in a case of pleurisy 
communicated to me by Dr. Mitchell, of Kentuckv, very 



DEFENCE OF BLOOD-LETTING. 205 

different appearances. That which was taken from one 
arm was sizy, while that which was taken from the other 
was of a scarlet colour. 1 have known a similar differ- 
ence to occur in, the appearances of the blood in preg- 
nancy. That which was taken from the arm of the right 
side, was much more sizy than that which was taken 
from the left. Blood which is drawn from a vein in the 
arm, puts on, likewise, appearances very different from 
that which is discharged from the bowels, in a dysentery. 
These facts were alluded to in the Outlines of the Phe- 
nomena of Fever,* in order to prove that unequal excite- 
ment takes place, not only in the different systems of the 
body, but in the same system, particularly in the blood- 
vessels. They likewise show us the necessity of attend- 
ing to the state of the pulse in both arms, as well as in 
other parts of the body, in prescribing blood-letting. 
When time, and more attention to that index of the state 
of the system in fevers, shall have brought to light all 
the knowledge that the pulse is capable of imparting, the 
appearances of the blood, in fevers, will be regarded as 
little as the appearances of the urine. 

XI. Blood-letting should always be copious where 
there is danger from sudden and great congestion or 
inflammation, in vital parts. This danger is indicated 
most commonly by pain ; but there may be congestion 
in the lungs, liver, bowels, and even in the head, without 
pain. In these cases, the state of the pulse should always 
govern the use of the lancet. An advantage will arise in 
these cases from drawing blood at the same time from 
both arms. An alarm, Mr. Hunter says, is thereby ex- 
cited in the arteries, which disposes them to contract 
more suddenly, and thus to relieve themselves of redun- 
dant blood. Eight ounces drawn in two minutes in the 
eases under consideration, give more relief than a much 
larger quantity in a longer time. The good effects of a 
large stream of blood in violent and inflammatory diseases 
did not escape Dr. Sydenham. The reverse of this prac- 
tice should be followed in fevers of weak inflammatory 
action. 

* Vol. iii. 



206 DEFENCE OF BLOOD-LETTING, 

XII. What quantity of blood may be taken, with 
safety, from a patient in an inflammatory fever ? To 
answer this question it will be necessary to remark, 
1. That, in a person of an ordinary size, there are suppo- 
sed to be contained between 25 and 28 pounds of blood ; 
and 2. That much more blood may be taken when the 
blood-vessels are in a state of morbid excitement and 
excitability, than at any other time. One of the uses of 
the blood is to stimulate the blood-vessels, and thereby 
to assist in originating and preserving animal life. In a 
healthy state of the vessels, the whole mass of the blood 
is necessary for this purpose ; but in their state of mor- 
bid excitability, a much less quantity of blood than what 
is natural (perhaps in some cases four or five pounds) 
are sufficient to keep up an equal and vigorous circula- 
tion. Thus very small portions of light and sound are 
sufficient to excite vision and hearing, in an inflamed and 
highly excitable state of the eyes and ears. Thus too, a 
single glass of wine will often produce delirium in a fever 
in a man, who, when in health, is in the habit of drinking 
a bottle every day, without having his pulse quickened 
by it. 

An ignorance of the quantity of blood which has been 
drawn by design, or lost by accident, has contributed 
very much to encourage prejudices against blood-letting. 
Mr. Cline drew 320 ounces of blood in 20 days from a 
patient in St. Thomas's hospital, who laboured under a 
contusion of the head. But this quantity is small com- 
pared with the quantity lost by a number of persons, 
whose cases are recorded by Dr. Haller.* I shall men- 
tion a few of them. One person lost 9 pounds of blood, 
a second 12, a third 18, and a fourth 22, from the nose, 
at one time. A fifth lost 12 pounds by vomiting in one 
night, and a sixth 22 from the lungs. A gentleman at 
Angola lost between 3 and 4 pounds daily from his nose. 
To cure it, he was bled 97 times in one year. A young 
woman was bled 1020 times in 19 years, to cure her of 
plethora which disposed her to hysteria. Another young 
woman lost 125 ounces of blood, by a natural hemor- 
rhage, every month. To cure it, she was bled every day, 
* Elemcnta Physiologic, vol. iv. p. 45. 



DEFENCE OF BLOOD-LETTING. 207 

and every other day, for 14 months. In none of these 
instances was death the consequence of these great evacu- 
ations of blood. On the contrary, all the persons alluded 
to, recovered. Many similar instances of the safety, and 
even benefit of profuse discharges of blood, by nature and 
art, might Jbe mentioned from other authors. I shall in- 
sert only one more, which shall be taken from Dr. Syden- 
ham's account of the cure of the plague. " Among the 
other calamities of the civil war which afflicted this nation, 
the plague also raged in several places, and was brought 
by accident from another place to Dunstar Castle, in So- 
mersetshire, where some of the soldiers dying suddenly, 
with an eruption of spots, it likewise seized several others. 
It happened at that time that a surgeon, who had travel- 
led much in foreign parts, was in the service there, and ap- 
plied to the governor for leave to assist his fellow- soldiers 
who were afflicted with this dreadful disease, in the best 
manner he was able ; which being granted, he took so 
large a quantity of blood from every one at the beginning 
of the disease, and before any swelling was perceived, that 
they were read}' to faint, and drop down, for he bled them 
all standing, and in the open air, and had no vessel to 
measure the blood, which falling on the ground, the quan- 
tity each person lost could not of course be known. The 
operation being over, he ordered them to lie in their tents ; 
and though he gave no kind of remedy after bleeding, vet 
of the numbers that were thus treated, not a single person 
died. I had this relation from Colonel Francis Wind- 
ham, a gentleman of great honour and veracity, and at this 
time governor of the castle."* 

Again. An ignorance of the rapid manner in which 
blood is regenerated, when lost or drawn, has helped to 
keep up prejudices against blood-letting. A person (Dr. 
Haller says) lost five pounds of blood daily from the 
hemorrhoidal vessels for 62 days, and another 75 pounds 
of blood in 10 days. The loss each day, was supplied 
by fresh quantities of aliment, and where no aliment is ta- 
ken into the stomach, by the blood that is prepared from 
the chyle which is secreted in the liver from the fat of the 
omentum. I have supposed in my physiological lectures 
that the omentum performs the vicarious purpose that has 

•Vol. i. p. i 



208 DEFENCE OF BLOOD-LETTING. 

been mentioned. This opinion has been defended and 
applied to practical purposes by my son Dr. James Rush 
in his inaugural dissertation published in April 1809. 
One of the inferences drawn from it, is a caution not to 
lay aside the lancet in chronic diseases with inflammatory 
symptoms, from a fear of a penury of blooo^ in cases 
where the resources for its reproduction have failed from 
the abstraction of food, or a deficiency of the functions of 
the stomach, and where the liver retains the chylopoetic 
office he has ascribed to it. 

These facts, I hope, will be sufficient to establish the 
safety and advantages of plentiful blood-letting, in t 
of violent fever ; also to show the fallacy and danger of 
that practice which attempts the cure of such cases of 
fever, by what is called moderate bleeding. There arc, it 
has been said, no half truths in government. It is equally 
true, that there are no half truths in medicine. This half- 
way practice of moderate bleeding, has kept up the mor- 
tality of pestilential fevers, in all ages and in all countries. 
I have combated this practice elsewhere,* and have assert- 
ed, upon the authority of Dr. Sydenham, that it is much 
better not to bleed at all, than to draw blood disproportion- 
ed in quantity to the violence of the fever. If the state of 
the pulse be our guide, the continuance of its inflamma- 
tory action, after the loss of even 100 ounces of blood, 
indicates the necessity of more bleeding, as much as it did 
the first time a vein was opened. In the use of this reme- 
dy it may be truly said, as in many of the entcrprizes of 
life, that nothing is done, while any thing remains to be 
done. Bleeding should be repeated while the symptoms 
which first indicated it continue, should it be until four- 
fifths of the blood contained in the body are drawn away. 
In this manner we act in the use of other remedies. Who 
ever leaves oft' giving purges in a colic, attended with cos- 
tiveness, before the bowels are opened ? or who lavs aside 
mercury as a useless medicine, because a few doses of it 
do not cure the venereal disease ? 

I shall only add under this head, that I have always 
observed the cure of a malignant fever to be most com- 
plete, and the convalescence to be most rapid, when the 
bleeding has been continued until a paleness is induced 
* Account of the Yellow Fever in 1/93. 



DEFENCE OF BLOOD-LETTING. 209 

in the face, and until the patient is able to sit up without 
being fainty. After these circumstances occur, a moder- 
ate degree of force in the pulse will gradually wear itself 
away, without doing any harm. 

XIII. In drawing blood, the quantity should be large 
or small at a time, according to the state of the system. 
In cases where the pulse acts with force and freedom, 
from 10 to 20 ounces of blood may betaken at once ; but 
in cases where the pulse is much depressed, it will be 
better to take away but a few ounces at a time, and to 
repeat it three or four times a day. By this means the 
blood-vessels more gradually recover their vigour, and 
the apparent bad effects of bleeding are thereby prevented. 
Perhaps the same advantages might be derived in many 
other cases, from the gradual abstraction of stimuli, that 
are derived from the gradual increase of their force and 
number, in their application to the body. For a number 
of facts in support of this practice, the reader is referred 
to the history of the yellow fever, in the year 1793. In 
an inflammatory fever, the character of which is not ac- 
curately known, it is safest to begin with moderate bleed- 
ing, and to increase it in quantity, according as the vio- 
lence and duration of the disease shall make it necessary. 
In fevers, and other diseases, which run their courses in 
a few days or hours, and which threaten immediate dis- 
solution, there can be no limits fixed to the quantity of 
blood which may be drawn at once, or in a short time. 
Botallus drew three, four and five pints in a day, in such 
cases. Dr. Jackson drew fifty-six ounces of blood at one 
time, from a Mr. Thompson, of the British hospitals, in 
a fever of great violence and danger. This patient was 
instantly relieved from what he styled " chains and hor- 
rors." In three or four hours he was out of danger, and 
in four days, the doctor adds, returned to his duty.* Dr. 
Physick drew ninety ounces, by weight, from Dr. De- 
wees, in a sudden attack of the apoplectic state of fever, 
at one bleeding, and thereby restored him so speedily to 
health, that he was able to attend to his business in three 
days afterwards. Under this head I shall remark that 

* Remarks on the Constitution of the Medical Department of the 
British Army. 

VOL. IV. B « 



210 DEFENCE OF BLOOD-LETTING. 

bleeding ad deliquium animi is often attended with obvious 
good effects in the first stage of violent diseases. By the 
total relaxation it induces in the blood-vessels, it enables 
the stimuli which support animal life, to impart to them 
a new, and natural action, and thereby suddenly to restore 
their equable excitement, but this mode of bleeding should 
never be employed in the advanced, or last stages of fever. 
I have once known death to be thus induced by it. The 
system requires all its resources in excitability to be re- 
stored from a fainting fit, and these exist only in the early 
or acute stages of disease. In chronic states of fever, of an 
inflammatory type, small and frequent bleedings, are to be 
preferred to large ones. We use mercury, antimony, and 
diet drinks as alteratives in many diseases with advantage. 
We do not expect to remove debility by two or three im- 
mersions in a cold bath. We persist with patients in pre- 
scribing all the above remedies for months and years, be- 
fore we expect to reap the full benefits of them. Why 
should not blood-letting be used in the same way, and have 
the same chance of doing good ? I have long ago adopted 
the alterative mode of using it, and I can now look around 
me, and with pleasure behold a number of persons of both 
sexes who owe their lives to it. In many cases I have pre- 
scribed it once in two or three months, for several years, 
and in some I have advised it every two weeks, for several 
months. 

There is a state of fever in which an excess in the ac- 
tion of the blood-vessels is barely perceptible, but which 
often threatens immediate danger to life, by a determina- 
tion of blood to a vital part. In this case I have frequently 
seen the scale turn in favour of life, by the loss of but 
four or five ounces of blood. The pressure of this* and 
even of a much less quantity of blood in the close of a 
fever, I believe, as effectually destroys life as the excess 
of several pounds does in its beginning. The advantage 
to be derived from the loss of a small quantity of blood 
in certain states of the system is obvious, from the sudden 
relief which the discharge of a few ounces of blood by 
menstruation affords to the pains which sometimes attend 
that monthly disease. 



DEFENCE OF BLOOD-LETTING. 211 

In cases where bleeding does not cure, it maybe used 
with advantage as a palliative remedy. Many diseases 
induce death in a full and highly excited state of the sys- 
tem. Here opium does harm, while bleeding affords cer- 
tain relief. It belongs to this remedy, in such cases, to 
ease pain, to prevent convulsions, to compose the mind, 
to protract the use of reason, to induce sleep, and thus 
to smooth the passage out of life. 

XIV. Bleeding from an artery, commonly called arte- 
riotomy, would probably have many advantages over ve- 
nesection, could it be performed at all times with ease 
and safety. Blood discharged by haemorrhages affords 
more relief, in fevers, than an equal quantity drawn from 
a vein, chiefly because it is poured forth, in the former 
case, from a ruptured artery. I mentioned formerly, that 
Dr. Mitchell had found blood drawn from artery to be 
what is called dense, at a time when that which was drawn 
from a vein, in the same persons, was dissolved. This 
fact may possibly admit of some application. In the close 
of malignant fevers, where bleeding has been omitted in 
the beginning of the disease, blood drawn from a vein is 
generally so dissolved, as to be beyond the reach of repeat- 
ed bleedings to restore it to its natural texture. In this case, 
arteriotomy might probably be performed with advantage. 
The arteries, which retain their capacity of life longer 
than the veins, by being relieved from the immediate 
pressure of blood upon them, might be enabled so to act 
upon the torpid veins, as to restore their natural action, 
and thereby to arrest departing life. Arteriotomy might 
further be used with advantage in children, in whom it is 
difficult, and sometimes impracticable to open a vein. 
Besides these advantages, there are several others which 
attend this mode of drawing blood. 1. The arteries being 
more irritable than the veins, the abstraction of blood im- 
mediately from them, removes the stimulus from the part 
which is the seat of the most irritation or diseased action. 
2. More blood can be taken from the arteries without 
bringing on fainting, than from the veins, in consequence 
of the heart (on the suspension of whose actions fainting 
depends) driving the blood which moves it from the veins. 
This is of great consequence in the close of fevers in 



212 DEFENCE OF BLOOD-LETTING. 

which bleeding may be necessary, but in which fainting 
is sometimes fatal. It may be used with greater safety 
for the same reason in pregnancy, where there is a dis- 
position to faint, the effect of which is sometimes to in- 
duce abortion. 3. The arteries when opened, are more 
apt to assume a morbid action from the wound inflicted 
upon them than the veins, in consequence of which, a dis- 
eased action is more easily translated from an internal, to an 
external and less vital part of the body. 4. More relief is ob- 
tained by the loss of a small quantity of blood, from an ar- 
tery than from a vein. These four remarks in favour of ar- 
teriotomy are taken from Dr. Butler's thesis, published 
in Edinburg. They appear to be rational, but I can say 
but little in support of them from my own experience. 

XV. Much has been said about the proper place from 
whence blood should be drawn. Bleeding in the foot was 
much used formerly, in order to excite a revulsion from 
the head and breast ; but our present ideas of the circu- 
lation of the blood have taught us, that it may be drawn 
from the arm with equal advantage in nearly all cases. 
To bleeding in the foot there are the following objections: 
1. The difficulty of placing a patient in a situation favour- 
able to it. 2. The greater danger of wounding a tendon 
in the foot than in the arm. And, 3. The impossibility 
of examining the blood after it is drawn ; for, in this mode 
of bleeding, the blood generally flows into a bason or pail 
of water. 

Under this head I shall decide upon the method of 
drawing blood by means of cups and leeches, in the in- 
flammatory state of fever. Where an inflammatory fever 
arises from local affection, or from contusion in the head 
or breast, or from a morbid excitement in those, above 
other parts of the arterial system, they may be useful; 
but where local affection is a symptom of general and 
equable fever only, it can seldom be necessary, except 
where bleeding from the arm has been omitted, or used 
too sparingly, in the beginning of a fever ; by which means 
such fixed congestion often takes place, as will not yield 
to general bleeding. 

XVI. Much has been said likewise about the proper 
time for bleeding in fevers. It may be used at all times, 



DEFENCE OF BLOOD-LETTING. 213 

when indicated by the pulse and other circumstances, in 
continual fevers ; but it should be used chiefly in the par- 
oxysms of such as intermit. I have conceived this prac- 
tice to be of so much consequence, that, when I expect a 
return of the fever in the night, I request one of my pu- 
pils to sit up with my patients all night, in order to meet 
the paroxysm, if necessary, with the lancet. But I de- 
rive another advantage from fixing a centinel over a patient 
in a malignant fever. When a paroxysm goes off in the 
night, it often leaves the system in a state of such ex- 
treme debility, as to endanger life. In this case, from five 
to ten drops of laudanum, exhibited by a person who is a 
judge of the pulse, obviate this alarming debility, and 
often induce easy and refreshing sleep. By treating the 
human body like a corded instrument, in thus occasion- 
ally relaxing or bracing the system, according to the ex- 
cess or deficiency of stimulus, in those hours in which 
death most frequently occurs, I think I have been the 
means of saving several valuable lives. 

XVII. The different positions of the body influence 
the greater or less degrees of relief which are obtained by 
blood-letting. Where there is a great disposition to syn- 
cope, and where it is attended with alarming and distres- 
sing circumstances, blood should be drawn in a recum- 
bent posture, but where there is no apprehension or dread 
of fainting, it may be taken in a sitting posture. The re- 
lief will be more certain if the patient be able to stand 
while he is bled, for by thus opposing the gravity of the 
blood, to the action of the heart, the quantity of it usually 
sent to the head, is lessened. It is diminished likewise in 
the larger blood-vessels by the abstraction of that portion 
of it which is necessary to the excitement of the muscles 
in a standing posture, and hence fainting, and all the good 
effects we wish from it in the first stage of disease may be 
more easily obtained and these too from the loss of a much 
smaller quantity of blood. It should therefore be preferred, 
where patients object to copious or frequent bleedings. 
The history of the success of this practice in the British 
army, recently mentioned from Dr. Sydenham, furnishes 
a strong argument in its favour. 

I regret that the limits I have fixed to this Defence of 
Blood-letting will not admit of my applying the principles 



214 DEFENCE OP BLOOD-LETTING. 

which have been delivered, to all the inflammatory states of 
fever. In a future essay, I hope to establish its efficacy in 
the manaical state of fever. I have said that madness is 
the effect of a chronic inflammation in the brain. Its reme- 
dy, of course, should be frequent and copious blood-let- 
ting. Physical and moral evil are subject to similar laws. 
The mad shirt, and all the common means of coercion, 
are as improper substitutes for bleeding, in madness, as 
the whipping-post and pillory are for solitary confinement 
and labour, in the cure of vice. The pulse should govern 
the use of the lancet in this as well as in all the ordinary 
states of fever. It is the dial-plate of the system. But in 
the misplaced states of fever, the pulse, like folly in old 
age, often points at a different mark from nature. In all 
such cases, we must conform our practice to that which 
has been successful in the reigning epidemic. A single 
bleeding, when indicated by this circumstance, often con- 
verts a fever from a suffocated, or latent, to a sensible 
state, and thus renders it a more simple and manageable 
disease. 

It was worthy of consideration here, how far local dis- 
eases, which have been produced by fevers, might be 
cured by re-exciting the fever. Sir William Jones says, 
the physicians in Persia always begin the cure of the lep- 
rosy by blood-letting.* Possibly this remedy diffuses the 
disease through the blood-vessels, and thereby exposes it 
to be more easily acted upon by other remedies. 

Having mentioned the states of fever in which blood- 
letting is indicated, and the manner in which it should be 
performed, I shall conclude this inquiry by pointing out 
the states of fever in which it is forbidden, or in which it 
should be cautiously or sparingly performed. This sub- 
ject is of consequence, and should be carefully attended 
to by all who wish well to the usefulness and credit of the 
lancet. 

1. It is forbidden in that state of fever, as well as in 
other diseases, in which there is reason to believe the brain 
or viscera are engorged with blood, and the whole system 
prostrated below the point of re-action. I have suggested 
this caution in another place, f The pulse in these cases 
is feeble, and sometimes scarcely perceptible, occasioned 
• Asiatic Essays. f Vol. iii. 



DEFENCE OF BLOOD-LETTING. 215 

by the quantity of blood in the blood-vessels being redu- 
ced, in consequence of the stagnation of large portions in 
the viscera. By bleeding in these cases, we deprive the 
blood-vessels of the feeble remains of the stimulus which 
keep up their action, and thereby precipitate death. The 
remedies here should be frictions, and stimulating applica- 
tions to the extremities, and gentle stimuli taken by the 
mouth, or injected into the bowels. As soon as the sys- 
tem is a little excited by these remedies, blood may be 
drawn, but in small quantities at a time, and perhaps only by 
means of cups or leeches applied to the seats of congestions 
of the blood. After the vessels are excited by the equable 
diffusion of the blood through all their parts, it may with 
safety be drawn from the arm, provided it be indicated 
by the pulse. 

2. It is seldom proper beyond the third day, in a ma- 
lignant fever, if it has not been used on the days previous 
to it, and for the same reason that has been given under 
the former head. Even the tension of the pulse is not al- 
ways a sufficient warrant to bleed, for in three days in a 
fever which runs its course in five days, the disorganiza- 
tion of the viscera is so complete, that a recovery is scarcely 
to be expected from the lancet. The remedies which give 
the only chance of relief in this case, are purges, blisters, 
and a salivation. 

3. Where fevers are attended with paroxysms, bleed- 
ing should be omitted or used with great caution, in the 
close of those paroxysms. The debility which accom- 
panies the intermission of the fever is often so much in- 
creased by the recent loss of blood, as sometimes to en- 
danger life. 

4. Bleeding is forbidden, or should be used cautiously 
in that malignant state of fever, in which a weak morbid 
action, or what Dr. Darwin calls a tendency to inirrita- 
bility, takes place in the blood-vessels. It is known by a 
weak and frequent pulse, such as occurs in the typhus fe- 
ver and in the plague in warm climates. I have often met 
with it in the malignant sore throat, and occasionallv in 
the pleurisy and yellow fever. The remedies here should 
be gentle vomits or purges, and afterwards cordials. 
Should the pulse be too much excited by them, bleeding 
may be used to reduce it. 



216 DEFENCE OF BLOOD-LETTING. 

5. It should be used sparingly in the diseases of habit- 
ual drunkards. The morbid action in such persons, 
though often violent, is generally transient. It may be 
compared to a soap-bubble. The arteries, by being often 
overstretched by the stimulus of strong drink, do not al- 
ways contract with the diminution of blood, and such pa- 
tients often sink, from this cause, from the excessive use 
of the lancet. 

6. It has been forbidden after the suppurative process 
has begun in local inflammation. It constantly retards the 
suppuration, when begun, in the angina tonsillaris, and 
thus protracts that disease. To this rule there are fre- 
quent exceptions. 

7. It should be omitted in pneumony, after copious ex- 
pectoration has taken place. This discharge is local de- 
pletion, and, though slow in its effects compared with 
bleeding, it serves the same purpose in relieving the lungs. 
The lancet can only be required where great pain in cough- 
ing, and a tense pulse, attends this stage of the disease. 

8. It may be omitted (except when the blood-vessels 
are insulated) in those diseases in which there is time to 
wait, without danger to life, or future health, for the 
circuitous operation of purging medicines, or abstemious 
diet. 

9. It should be avoided, when it can be done without 
great danger to life, where there is a great and constitu- 
tional dread of the operation ; also in persons predisposed 
to fainting, where that occasional effect of bleeding is not 
desired. In such cases, it has sometimes done harm to 
the patient, and injured the credit of the lancet. 

10. There are cases in which sizy blood should not 
warrant a repetition of blood-letting. Mr. White informs 
us, in the History of the Bilious Fever which has lately 
prevailed at Bath, that bleeding, in many cases in which 
this appearance of the blood took place, was useless or 
hurtful. Sir John Pringle says the same unsuccessful 
issue attended a second bleeding when the blood was sizy 
in the hospital fever. In some of the fevers of our own 
country, we sometimes see sizy blood followed by symp- 
toms which forbid the repeated use of the lancet, but 
which yield to other depleting remedies, or to such as are 
of a cordial nature. I have seen the same kind of blood, 



DEFENCE OF BLOOD-LETTING. 21? 

a few hours before death, in a pulmonary consumption, 
and three days after a discharge of a gallon and a half of 
blood from the stomach by vomiting. 

11. Even a tense pulse does not always call for the re- 
peated use of the lancet. I have mentioned one case, viz. 
on the third or fourth days of a malignant fever, in which 
it is improper. There are instances of incurable consump- 
tions from tubercles and ulcers in the lungs, in which the 
pulse cannot be made to feel the least diminution of ten- 
sion by either copious or frequent bleedings. There are 
likewise cases of hepatic fever, in which the pulse Can- 
not be subdued by this remedy. This tense state of the 
pulse is the effect of a suppurative process in the liver. If 
a sufficient quantity of blood has been drawn in the first 
stage of this disease, there is little danger from leaving the 
pulse to reduce or wear itself down by a sudden or grad- 
ual discharge of the hepatic congestion. The recovery 
in this case is slow, but it is for the most part certain. I 
have once known a dropsy and death induced by the con- 
trary practice. 

12. and lastly. There is sometimes a tension in the 
pulse in haemorrhages, that will not yield to the lancet. 
The man whose blood was sizy, three days after losing a 
gallon and a half of it from his stomach, had a tense pulse 
the day before he died ; and I Once perceived its last 
strokes to be tense, in a patient whom I lost in a yellow 
fever by a haemorrhage from the nose. The only circum- 
stance that can justify bleeding in these cases is extreme 
pain, in which case, the loss of a few ounces of blood is 
a more safe and effectual remedy than opium. 

I shall now add a few remarks upon the efficacy of 
blood-letting, in diseases which are not supposed to belong 
to the class of fevers, and which have not been included 
in the preceding volumes. 

I. The philosophers, in describing the humble origin 
of man, say that he is formed " inter stercuset urinani." 
The divines say that he is " conceived in sin and shapen 
in iniquity." I believe it to be equally true, and alike 
humiliating, that he is conceived and brought forth in 
disease. 

vol. iv. se 



218 DEFENCE OF BLOOD-LETTING. 

This disease appears in pregnancy and parturition. I 
shall first endeavour to prove this to be the case, and after- 
wards mention the benefits of blood-letting in relieving 
it, in both cases. 

In pregnancy, the uterus is always affected with that 
grade of morbid action which I formerly called inflamma- 
tion. This is evident from its exhibiting all its usual 
phsenomena in other parts of the body. These are, 

1. Swelling, or enlargement. 

2. Haemorrhage. The lochia are nothing but a slow 
and spontaneous bleeding performed by nature, and in- 
tended to cure the inflammation of the uterus after partu- 
rition. 

3. Abscesses, schirri, and cancers. It is true, those 
disorders sometimes occur in women that have never borne 
children. In these cases, they are the effects of the in- 
flammation excited by the menstrual disease. 

4. A full, quick, and tense or frequent pulse ; pain ; 
want of appetite;* sickness at stomach ; puking; syn- 
cope ; and sometimes convulsions in every part of the 
body. 

5. Sizy bood. This occurs almost uniformly in preg- 
nancy. 

6. A membrane Dr. Scarpa has proved the membrana 
decidua, which is formed during pregnancy, to be in every 
respect the same in its properties with the membrane which 
is formed upon other inflamed surfaces, particularly the 
trachea, the pleura, and the inside of the bowels. Thus we 
see all the common and most characteristic symptoms and 
effects of inflammation, in other parts of the body, are 
exhibited by the uterus in pregnancy. 

These remarks being premised, I proceed to remark, 
that blood-letting is indicated, in certain states of preg- 
nancy, by all the arguments that have been used in favour 
of it in any other inflammatory disease. The degree of 
inflammation in the womb, manifested by the pulse, pain, 
and other signs of disease, should determine the quantity 
of biood to be drawn. Low diet, gentle purges, and con- 

* Dr. Hunter used to teach in his lectures, that the final cause of the 
want of appetite, dur.ng the first months of pregnancy, was to obviate 
plethora, which disposed to aboitiou. This plethora should have been 
called an inflammatory disease, in which abstinence is useful. 



DEFENCE OF BLOOD-LETTING. 219 

stant exercise, are excellent substitutes for it, but where 
they are not submitted to, blood-letting should be em- 
ployed as a substitute for them. In that disposition to 
abortion, which occurs about the third month of pregnan- 
cy, small and frequent bleedings should be preferred to all 
other modes of depletion. I can assert from experience, 
that they prevent abortion, nearly with as much certainty 
as they prevent a haemorrhage from the lungs : for what is 
an abortion but a haemoptysis (if I may be allowed the 
expression) from the uterus? During the last month of 
pregnancy, the loss of from twelve to twenty ounces of 
blood has the most beneficial effects, in lessening the 
pains and danger of child-birth, and in preventing its 
subsequent diseases. 

The doctrine I have aimed to establish leads, not only 
to the use of blood-letting in the disease of pregnancy, 
when required, but to a more copious use of it, when 
combined with other diseases, than in those diseases in a 
simple state. This remark applies, in a particular manner, 
to those spasms and convulsions which sometimes occur 
in the latter months of pregnancy. Without bleeding, 
they are always fatal. By copious bleeding, amounting 
in some instances to 80 and 100 ounces, they are generally 
cured. 

Let it not be supposed that blood-letting is alike pro- 
per and useful in every state of pregnancy. — There are 
what are called slow or chronic inflammations, in which 
the diseased action of the blood-vessels not only forbids 
it, but calls for cordial and stimulating remedies. The 
same feeble state of inflammation sometimes take place in 
the pregnant uterus. In these cases cordials and stimu- 
lants should be preferred to the lancet. 

Parturition is a higher grade of disease than that which 
takes place in pregnancy. It consists of convulsive or 
clonic spasms in the uterus, supervening its inflammation, 
and is accompanied with chills, heat, thirst, a quick, full, 
tense, or a frequent and depressed pulse, and great pain. 
By some divines these symptoms, and particularly pain, 
have been considered as a standing and unchangeable 
punishment of the original disobedience of woman, and, 
by some physicians, as indispensably necessary to enable 



220 DEFENCE OF BLOOD-LETTING. 

the uterus to relieve itself of its burden. By contem- 
plating the numerous instances in which it has pleased 
God to bless the labours and ingenuity of man, in lessen- 
ing or destroying the effects of the curse inflicting upon 
the earth, and by attending to the histories of the tccal ex- 
emption from pain in child bearing that are recorded of 
the women in the Brasils, Calabria, and some parts of 
Africa, and of the small degrees of it which are felt by the 
Turkish women, who reduce their systems by frequent 
purges of sweet oil during pregnancy, I was induced to 
believe pain does not accompany child-bearing by an im- 
mutable decree of Heaven. By recollecting further how 
effectually blood-letting relieves many other spasmodic 
and painful diseases, and how suddenly it relaxes rigidity 
in the muscles, I was led, in the year 1795, to suppose 
it might be equally effectual in lessening the violence of 
the disease and pains of parturition. I was encouraged 
still more to expect this advantage from it, by having re- 
peatedly observed the advantages of copious bleeding for 
inflammatory fevers, just before delivery, in mitigating 
its pains, and shortening its duration. Upon my men- 
tioning these reflections and facts to Dr. Dewees, I was 
much gratified in being informed that he had been in the 
practice, for several years before his removal from Abing- 
don to Philadelphia, of drawing large quantities of blood 
during parturition, and with all the happy effects 1 had ex- 
pected from it. The practice has been strongly inculcated 
by the doctor in his lectures upon midwifery, and has been 
ably defended and supported by a number of recent facts, 
in an ingenious inaugural dissertation, published by Dr. 
Peter Miller, in the year 1804. It has been generally 
adopted by the practitioners of midwifery, of both sexes, 
in Philadelphia. 

I do not mean to insinuate that bleeding is a new remedy 
in parturition. It has long ago been advised and used in 
France, and even by the midwives of Genoa, in Italy, 
but never, in any country, in the large quantities that have 
been recommended by Dr. Dewees, that is, from 20 to 
80 ounces, or until signs of fainting are induced, nor 
under the influence of the theory of parturition, being a 
violent disease. 



DEFENCE OF BLOOD-LETTING. 221 

But the advantages of this remedy are not confined to 
lessening the pains of delivery. It prevents after pains ; 
favours the easy and healthy secretion of milk ; prevents 
sore breasts, swelled legs, puerperile fever, and all the 
distressing train of anomalous complaints that often fol- 
low child-bearing. Dr. Hunter informed his pupils, in 
his lectures upon midwifery, in the year 1769, that he had 
often observed the most rapid recoveries to succeed the 
most severe labours. The severity of the pains in these 
cases created a disease, which prevented internal conges- 
tions in the womb. Bleeding, by depleting the uterus, 
obviates at once both disease and congestion. Its effica- 
cy is much aided by means of glysters, which, by emp- 
tying the lower bowels, lessen the pressure upon the 
uterus. 

Let it not be inferred, from what has been said in fa- 
vour of blood-letting in parturition, that it is proper in all 
cases. Where there has been great previous inanition, 
and where there are marks of languor, and feeble morbid 
action in the system, the remedies should be of an oppo- 
site nature. Opium and other cordials are indicated in 
these cases. Their salutary effects in exciting the action 
of the uterus, and expediting delivery, are too well known 
to be mentioned. 

I have expressed a hope in another place,* that a me- 
dicine would be discovered that should suspend sensibili- 
ty altogether, and leave irritability, or the powers of mo- 
tion, unimpared, and thereby destroy labour pains alto- 
gether. I was encouraged to cherish this hope, by having 
known delivery to take place, in one instance, during a 
paroxysm of epilepsy, and having heard of another, dur- 
ing a fit of drunkenness, in a woman attended by Dr. 
Church, in both of which there was neither conscious- 
ness, nor recollection of pain. 

2. During the period in which the menses are said to 
dodge, and for a year or two after they cease to flow, there 
is a morbid fulness and excitement in the blood-vessels, 
which are often followed by head-ach, cough, dropsy, 
haemorrhages, glandular obstructions, and cancers. They 
may all be prevented by frequent and moderate bleedings. 

* Medical Repository, vol. vi. 



222 DEFENCE OF BLOOD-LETTING. 

3. It has been proved, by many facts, that opium, 
when taken in an excessive dose, acts by inducing a sim- 
ilar state of the system with that which is induced by the 
miasmata which bring on malignant and inflammatory 
fevers. The remedy for the disease produced by it (where 
a vomiting cannot be excited to discharge the opium) 
has been found to be copious blood-letting. Of it effi- 
cacy, the reader will find an account in four cases, pub- 
lished in the fifth volume of the New- York Medical Re- 
pository. 

4. It is probable, from the uniformly stimulating man- 
ner in which poisons of all kinds act upon the human 
body, that bleeding would be useful in obviating their 
baneful effects. Dr. John Dorsey has lately proved its 
efficacy, in the case of a child that was affected with con- 
convulsions, in consequence of eating the leaves of the 
datura stramonium. 

5. It has been the misfortune of diabetes to be con- 
sidered by physicians as exclusively a local disease of 
weak morbid action, or as the effects of simple debility 
in the kidneys ; and hence stimulating and tonic medicines 
have been exclusively prescribed for it. This opinion is not 
a correct one. It often affects the whole arterial system, 
more especially in its first stage, with great morbid action. 
In two cases of it, where this state of the blood-vessels 
took place, I have used blood-letting with success, join- 
ed with the common remedies for inflammatory diseases. 

6. In intermitting fevers which have long resisted the 
use of bark, and all the common stimulating and tonic 
remedies which are employed to cure them, bleeding is 
generally a certain remedy. Many hundred instances of 
its efficacy in such cases could be mentioned from the re- 
cords of the practice in the Pennsylvania hospital, as well 
as from the private practice of many of the physicians of 
Philadelphia. 

7. In dislocated bones which resist both skill and force, 
it has been suggested, that bleeding, till fainting is in- 
duced, would probably induce such a relaxation in the 
muscles as to favour their reduction This principle was 
happily applied, in the winter of 1795, by Dr. Physick, 



DEFENCE OF BLOOD-LETTING. 223 

in the Pennsylvania hospital, in a case of dislocated hu- 
merus of two months continuance. The doctor bled his 
patient till he fainted, and then reduced his shoulder in 
less than a minute, and with very little exertion of force. 
The practice has since become general in Philadelphia, 
in luxations of large bones, where they resist the common 
degrees of strength employed to reduce them. 

In contemplating the prejudices against blood-letting, 
which formerly prevailed so generally in our country, I 
have been led to ascribe them to a cause wholly political. 
We are descended chiefly from Great- Britain, and have 
been for many years under the influence of English habits 
upon all subjects. Some of these habits, as far as they 
relate to government, have been partly changed ; but in 
dress, arts, manufactures, manners, and science, we are 
still governed by our early associations. Britain and France 
have been, for many centuries, hereditary enemies. The 
hostility of the former to the latter nation, extends to every 
thing that belongs to their character. It discovers itself, 
in an eminent degree, in diet and medicine. Do the French 
love soups? the English prefer solid flesh. Do the French 
love their meats well cooked? the English prefer their 
meats but half roasted. Do the French sip coffee after 
dinner? the English spend their afternoons in drinking 
Port and Madeira wines. Do the French physicians pre- 
scribe purges and glysters to cleanse the bowels? the 
English physicians prescribe vomits for the same purpose. 
Above all, do the French physicians advise bleeding in 
fevers? the English physicians forbid it in most fevers, 
and substitute sweating in the room of it. Here then we 
discover the source of the former prejudices and errors 
of our countrymen, upon the subject of blood-letting. 
They are of British origin. They have been inculcated 
in British universities, and in British books; and they 
accord as ill with our climate and state of society, as the 
Dutch foot stoves did with the temperate climate of the 
Cape of Good Hope. 

It is probable the bad consequences which have follow- 
ed the indiscriminate use of the lancet in France, and 
some other countries, may have contributed in some de- 
gree to create the prejudices against it, which are entertain- 



224 DEFENCE OF BLOOD-LETTING. 

ed by the physicians in Great-Britain. Bleeding, like 
opium, has lost its character in many cases, by being pre- 
scribed for the name of a disease. It is still used, Mr. 
Townsend tells us, in this empirical way in Spain, where 
a physician, when sent for to a patient orders him to be 
bled before he visits him. The late just theory of the 
manner in which opium acts upon the body, has restrained 
its mischief, and added greatly to its usefulness. In like 
manner, may we not hope, that just theories of diseases, 
and proper ideas of the manner in which bleeding acts in 
curing them, will prevent a relapse into the evils which 
formerly accompanied this remedy, and render it a great 
and universal blessing to mankind ? 



AN INQUIRY 



1ST0 THE 



COMPARATIVE STATE OF MEDICINE, 
IN PHILADELPHIA, 

BETWEEN 

THE YEARS 1760 AND 1766, AND THE YEAR 1809. 



VOL. IV. 



Ff 



AN INQUIRY, &c. 



IN estimating the progress and utility of medicine, 
important advantages may be derived from taking a view 
of its ancient, and comparing it with its present state. To 
do this upon an extensive scale, would be difficult, and 
foreign to the design of this inquiry. I shall therefore 
limit it, to the history of the diseases and medical opi- 
nions which prevailed, and of the remedies which were in 
use, in the city of Philadelphia, between the years 1760 
and 1766, and of the diseases, medical opinions, and re- 
medies of the year 1809. The result of a comparative 
view of each of them, will determine whether medicine 
has declined or improved, in that interval of time, in this 
part of the world. 

To derive all the benefits that are possible from such an 
inquiry, it will be proper to detail the causes, which, by 
acting upon the human body influence the subjects that 
have been mentioned, in those two remote periods of 
time. 

Those causes divide themselves into climate, diet, dress, 
and certain peculiar customs ; on each of which I shall 
make a few remarks. 

After what has been said, in the history of the Climate 
of Pennsylvania, in the second volume of these Inquiries, 
it will only be necessary in this place briefly to mention, 
that the winters in Philadelphia, between the years 1760 
and 1766, were almost uniformly cold. The ground was 
generally covered with snow, and the Delaware frozen, 
from the first or second week in December, to the last 
week in February, or the first week in March. Thaws 
were rare dining the winter months, and seldom of longer 
duration than three or four days. The springs began in 
May. The summers were generally warm, and the air 



228 STATE OF MEDICINE, 

seldom refreshed by cool north-west winds. Rains were 
frequent and heavy, and for the most part accompanied 
with thunder and lightning. The autumns began in Oc- 
tober, and were gradually succeeded by cool and cold 
weather. 

The diet of the inhabitants of Philadelphia, during 
those years, consisted chiefly of animal food. It was eaten, 
in some families, three times, and in all, twice a day. A 
hot supper was a general meal. To two and three meals 
of animal food in a day, many persons added what was 
then called " a relish," about an hour before dinner. It 
consisted of a slice of ham, a piece of salted fish, and 
now and then a beef-steak, accompanied with large 
draughts of punch or toddy. Tea was taken in the inter- 
val between dinner and supper. 

In many companies, a glass of wine and bitters was ta- 
ken a few minutes before dinner, in order to increase the 
appetite. 

The drinks, with dinner and supper, were punch and 
table beer. 

Besides feeding thus plentifully in their families, many 
of the most respectable citizens belonged to clubs, which 
met in the city in winter, and in its vicinity, under sheds, 
or the shades of trees, in summer, once and twice a week, 
and in one instance every night. They were drawn to- 
gether by suppers in winter, and dinners in summer. 
Their food was simple, and taken chiefly in a solid form. 
The liquors used with it were punch, London porter and 
sound old Madeira wine. 

Independently of these clubs, there were occasional 
meetings of citizens, particularly of young men, at taverns, 
for convivial purposes. A house in Water- street, known 
by the name of the Tun tavern, was devoted chiefly to this 
kind of accidental meetings. They were often followed 
by midnight sallies into the streets, and such acts of vio- 
lence and indecency, as frequently consigned the perpe- 
trators of them afterwards into the hands of the civil offi- 
cers and physicians of the city. 

Many citizens, particularly tradesmen, met every evening 
for the purpose of drinking beer, at houses kept for that 
purpose. Instances of drunkenness were rare at such places. 
The company generally parted at ten o'clock, and retired in 



BETWEEN 1760 AND 1766, AND 1809. 229 

an orderly manner to their habitations. Morning drams, 
consisting of cordials of different kinds, were common, both 
in taverns and private houses, but they were confined 
chiefly to the lower class of people. 

From this general use of distilled and fermented liquors, 
drunkenness was a common vice in all the different ranks 
of society, 

The dresses of the men, in the years alluded to, were 
composed of cloth in winter, and of thin woollen or silk 
stuffs in summer. Wigs composed the covering of the 
head, after middle life, and cocked hats were universally 
worn, except by the men who belonged to the society of 
friends. 

The dresses of the women, in the years before men- 
tioned, consisted chiefly of silks and callicoes. Stays 
were universal, and hoops were generally worn by the la- 
dies in genteel life. Long cloth or camblet cloaks were 
common, in cold weather, among all classes of women. 

The principal custom under this head, which influen- 
ced health and life, was that which obliged women, after 
lying in, "to sit up for company ;" that is to dress them- 
selves, every afternoon on the second week after confine- 
ment, and to sit for four or five hours, exposed to the im- 
pure air of a crowded room, and sometimes to long and 
loud conversations. 

Porches were nearly universal appendages to houses, and 
it was common for all the branches of a family to expose 
themselves upon them, to the evening air. Stoves were 
not in use at that time, in any places of public worship. 

Funerals were attended by a large concourse of citizens, 
who were thereby often exposed to great heat and cold, 
and sometimes to standing, while the funeral obsequies 
were performed, in a wet or damp church-yard. 

The human mind, in this period of the history of our 
citv, was in a colonized state, and the passions acted but 
feebly and partially upon literary and political subjects. 

We come now to mention the diseases which prevailed 
in our city between the years 1760 and 1766. 

The cholera morbus was a frequent disease in the sum 
mer months. 

Sporadic cases of dysentery were at that time com- 
mon. I have never seen that disease epidemic in Phila- 
delphia. 



230 STATE OF MEDICINE, 

The intermitting fever prevailed in the month of Au- 
gust, and in the autumn, chiefly in the suburbs and 
neighbourhood of the city. In the year 1765, it was 
epidemic in South wark, and was so general, at the same 
time, as to affect two thirds of the inhabitants of the 
southern states. This fact is mentioned by Dr. Bond, 
in a lecture preserved in the minutes of the managers of 
the Pennsylvania hospital. 

The slow chronic fever, called at that time the nervous 
fever, was very common, in the autumnal months, in the 
thickly settled parts of the city. 

The bilious fever prevailed, at the same time, in 
Southwark. The late Dr. Clarkson, who began to prac- 
tice medicine in that part of the city, in the year 1761, 
upon hearing some of his medical brethren speak of the 
appearance of bilious remittents in its middle and nor- 
thern parts, about the year 1778, said they had long been 
familiar to him, and that he had met with them every 
year since his settlement in Philadelphia.* 

The yellow fever prevailed in the neighbourhood of 
Spruce-street wharf, and near a filthy stream of water 
which flowed through what is now called Dock-street, 
in the year 1762. Some cases of it appeared likewise 
in Southwark. It was scarcely known in the north and 
west parts of the city. No desertion of the citizens took 
place at this time, nor did the fear of contagion drive the 
friends of the sick from their bed-sides, nor prevent the 
usual marks of respect being paid to them after death, 
by following their bodies to the grave. A few spora- 
dic cases of the same grade of fever appeared in the 
year 1763. 

Pneumonics, rheumatisms, inflammatory sore throats, 
and catarrhs were frequent during the winter and spring 
months. The last disease was induced, not only by sud- 

* From the early knowledge this excellent physician and worthy man 
had thus acquired of the bilious remitting fever, he was very successful 
in the treatment of it. It was by instruction conveyed by him to me with 
peculiar delicacy, that I was first taught the advantages of copious evac- 
uations from the bowels in that disease. I had been called, when a young 
practitioner, to \isit a gentleman with him in a bilious pleurisy. A third 
or fourth bleeding, which I advised, cured him. The doctor was much 
pleased with its effect, and said to me afterwards. " Doctor, you and I 
have each a great fault in our practice ; I do not bleed enough, you do 
uot purge tnough " 



BETWEEN 1760 AND 1766, AND 1809. 231 

den changes in the weather, but often by exposure to the 
evening air on porches in summer, and by the damp and 
cold air of places of public worship in winter. 

The influenza was epidemic in the city in the spring of 
the year 1761. 

The malignant sore throat proved fatal to a number of 
children in the winter of 1763. 

The scarlet fever prevailed generally in the year 1764. 
It resembled the same disease, as described by Dr. Syden- 
ham, in not being accompanied by a sore throat. 

Deadi from convulsions, in pregnant women, also from 
parturition, and the puerperile fever, were common be- 
tween the years 1760 and 1766. Death was likewise com- 
mon between the 50th and 60th years of life from gout, 
apoplexy, palsy, obstructed livers, and dropsies. A club, 
consisting of about a dozen of the first gentlemen in the 
city, all paid, for their intemperance, the forfeit of their 
lives between those ages, and most of them with some one, 
or more of the diseases that have been mentioned. I sat 
up with one of that club on the night of his death. Several 
of the members of it called at his house, the evening before 
he died, to inquire how he was. One of them upon being 
informed of his extreme danger, spoke in high and pa- 
thetic terms of his convivial talents and virtues, and said, 
" he had spent 200 evenings a year with him, for the 
last twenty years of his life." These evenings were all 
spent at public houses. 

The eolica pictonum, or dry gripes, was formerly a com- 
mon disease in this city. It was sometimes followed by 
a palsy of the upper and lower extremetics. Colics from 
crapulas were likewise very frequent, and now and then 
terminated in death. 

Many children died of the cholera infantum, cynanche 
trachealis, and hydrocephalus internus. The last disease 
was generally ascribed to worms. 

Fifteen or twenty deaths, occurred, every summer, from 
drinking cold pump water, when the body was in a highly 
excitable state, from great heat and labour. 

The small-pox, within the period alluded to, was some- 
times epidemic, and carried off many citizens. In the 
year 1759, Dr. Barnet was invited from Elizabeth-town, 
m New-Jersey, to Philadelphia, to inoculate for the small- 



232 STATE OF MEDICINE, 

pox. The practice, though much opposed, soon became 
general. About that time, Dr. Redman published a short 
defence of it, and recommended the practice to his fellow- 
citizens in the most affectionate language. The success 
of inoculation was far from being universal. Subsequent 
improvements in the mode of preparing the body, and 
treating the eruptive fever, have led us to ascribe this want 
of success to the deep wound made in the arm, to the ex- 
cessive quantity of mercury given to prepare the body, 
and to the use of a warm regimen in the eruptive fever. 

The peculiar customs and the diseases which have been 
enumerated, by inducing general weakness, rendered the 
pulmonary consumption a frequent disease among both 
sexes. 

Pains and diseases from decayed teeth were very com- 
mon between the years 1760 and 1766. At that time, 
the profession of a dentist was unknown in the city. 

The practice of physic and surgery were united, dur- 
ing those years, in the same persons, and physicians were 
seldom employed as man-midwives, except in preterna- 
tural and tedious labours. 

The practice of surgery was regulated by Mr. Sharp's 
treatise upon that branch of medicine. 

Let us now take a view of the medical opinions which 
prevailed at the above period, and of the remedies which 
were employed to cure the diseases that have been men- 
tioned. 

The system of Dr. Boerhaave then governed the practice 
of every physician in Philadelphia. Of course diseases 
were ascribed to morbid acrimonies, and other matters 
in the blood, and the practice of those years was influ- 
enced by a belief in them. Medicines were prescribed to 
thin, and to incrassate the blood, and diet drinks were 
administered in large quantities, in order to alter its quali- 
ties. Great reliance was placed upon the powers of na- 
ture, and critical days were expected with solicitude, in 
order to observe the discharge of the morbid cause of fe- 
vers from the system. This matter was looked for chiefly 
in the urine, and glasses to retain it were a necessary part 
of the furniture of every sick room. To ensure the dis- 
charge of the supposed morbid matter of fevers through 



BETWEEN 1760 AND 1766, AND 1809. 233 

the pores, patients were confined to their beds, and fresh, 
and even cool air, often excluded by close doors and 
curtains. The medicines to promote sweats were ge- 
nerally of a feeble nature. The spiritus mindereri, and 
the spirit of sweet nitre were in daily use for that pur- 
pose. In dangerous cases, saffron and Virginia snake- 
root were added to them. 

Blood-letting was used plentifully in pleurises and rheu- 
matisms, but sparingly in all other diseases. Blood was 
often drawn from the feet, in order to excite a revulsion 
of disease from the superior parts of the body. It was 
considered as unsafe, at that time, to bleed during the 
monthly disease of the female sex. 

Purges or vomits began the cure of all febrile diseases, 
but as the principal dependence was placed upon sweat- 
ing medicines, those powerful remedies were seldom re- 
peated in the subsequent stages of fevers. To this remark 
there was a general exception in the yellow fever of 1762. 
Small doses of glauber's salts were given every day after 
bleeding, so as to promote a gentle, but constant discharge 
from the bowels. 

The bark was administered freely in intermittents. The 
prejudices against it at that time were so general among 
the common people, that it was often necessary to dis- 
guise it. An opinion prevailed among them, that it lay 
in their bones, and that it disposed them to take cold. 
It was seldom given in the low and gangrenous states of 
fever, when they were not attended with remissions. 

The use of opium was confined chiefly to ease pain, 
to compose a cough, and to restrain preternatural dis- 
charges from the body. Such were the prejudices against 
it, that it was often necessary to conceal it in other me- 
dicines. It was rarely taken without the advice of a phy- 
sician. 

Mercury was in general use in the years that have been 
mentioned. 1 have said it was given to prepare the body 
for the small -pox. It was administered by my first pre- 
ceptor in medicine, Dr. Redman, in the same disease, 
when it appeared in the natural way, with malignant or 
inflammatory symptoms, in order to keep the salivary- 
glands open and flowing, during the turn of the pock> 

Vol. iv. eg 



234 STATE OF MEDICINE, 

He gave it likewise liberally in the dry gripes. In one 
case of that disease, I well remember the pleasure he ex- 
pressed, in consequence of its having affected his patient's 
mouth. 

But to Dr. Thomas Bond the city of Philadelphia is 
indebted for the introduction of mercury into general use, 
in the practice of medicine. He called it emphatically 
" a revolutionary remedy," and prescribed it in all dis- 
eases which resisted the common modes of practice. He 
gave it liberally in the cynanche trachealis. He sometimes 
cured madness, by giving it in such quantities as to excite 
a salivation. He attempted to cure pulmonary consump- 
tion by it, but without success ; for, at that time, the in- 
fluence of the relative actions of different diseases and 
remedies, upon the human body, was not known, or, if 
known, no advantage was derived from it in the practice 
of medicine. 

The dry gripes were cured, at that time, by a new and 
peculiar mode of practice, by Dr. Thomas Cadwallader. 
He kept the patient easy by gentle anodynes, and gave 
lenient purges only in the beginning of the disease ; nor 
did he ever assist the latter by injections till the fourth 
and fifth days, at which time the bowels discharged their 
contents in an easy manner. It was said this mode of 
cure prevented the paralytic symptoms, which sometimes 
follow that disease. It was afterwards adopted and highly 
commended by the late Dr. Warren, of London. 

Blisters were in general use, but seldom applied before 
the latter stage of fevers. They were prescribed, for the 
first time, in haemorrhages, and with great success, by 
Dr. George Glentworth. 

Wine was given sparingly, even in the lowest stage of 
what were then called putrid and nervous fevers. 

The warm and cold baths were but little used in pri- 
vate practice. The former was now and then employed 
in acute diseases. They were both used in the most 
liberal manner, together with the vapour and warm air 
baths, in the Pennsylvania hospital, by Dr. Thomas Bond. 
An attempt was made to erect warm and cold baths, in 
the neighbourhood of the city, and to connect them with 
a house of entertainment, by Dr. Lauchlin M'Clen, in 
the year 1761. The project was considered as unfriendly 



BETWEEN 1760 AND 1766, AND 1709. 235 

to morals, and petitions, from several religious societies, 
were addressed to the governor of the province, to pre- 
vent its execution. The enterprize was abandoned, and 
the doctor soon afterwards left the city. 

Riding on horseback, the fresh air of the seashore, ex- 
cursions to mineral springs, and long journies, were often 
prescribed to invalids, by all the physicians of that day. 

I come now to mention the causes which influence the 
diseases, also the medical opinions and remedies of the 
present time. In this part of our discourse, I shall fol- 
low the order of the first part of our inquiry. 

I have already taken notice of the changes which the 
climate of Philadelphia has undergone since the year 
1766. 

A change has of late years taken place in the dress of 
the inhabitants of Philadelphia. Wigs have generally 
been laid aside, and the hair worn cut and dressed in dif- 
ferent ways. Round hats, with high crowns, have be- 
come fashionable. Umbrellas, which were formerly a 
a part of female dress only, are now used in warm and 
wet weather, by men of all ranks in society ; and flannel 
is worn next to the skin in winter, and muslin in sum- 
mer, by many persons of both sexes. Tight dresses 
are uncommon, and stays are unknown among our wo- 
men. It is to be lamented that the benefits to health 
which might have been derived from the disuse of that 
part of female dress, have been prevented by the fashion 
of wearing such light coverings over the breasts and 
limbs. The evils from this cause, shall be mentioned 
hereafter. 

A revolution has taken place in the diet of our citi- 
zens. Relishes and suppers are generally abolished ; bit- 
ters, to provoke a preternatural appetite, also meridian 
bowls of punch, are now scarcely known. Animal food 
is eaten only at dinner, and excess in the use of it is 
prevented, by a profusion of excellent summer and winter 
vegetables. 

Malt liquors, or hydrant water, with a moderate quan- 
tity of wine, are usually taken with those simple and 
wholesome meals. 



236 STATE OF MEDICINE, 

Clubs, for the exclusive purpose of feeding, are dis- 
solved, and succeeded by family parties, collected for tl^e 
more rational entertainments of conversation, dancing-, 
music, and chess. Taverns and beer-houses are much 
less frequented than formerly, and drunkenness is rarely 
seen in genteel life. The tea table, in an evening, has 
now become the place of resort of both sexes, and the 
midnight serenade has taken place of the midnight revels 
of the young gentlemen of former years. 

In doing justice to the temperance of the modern citi- 
zens of Philadelphia, I am sorry to admit, there is still 
a good deal of secret drinking among them. Physicians, 
who detect it by the diseases it produces, often lament 
the inefficacy of their remedies to remove them In addi- 
tion to intemperance from spirituous liquors, a new spe- 
cies of intoxication from opium has found its way into 
our city. I have known death, in one instance, induced 
by it. 

The following circumstances have had a favourable in- 
fluence upon the health of the present inhabitants of Phi- 
ladelphia. 

The improvements in the construction of modern 
houses, so as to render them cooler in summer, and 
warmer in winter. 

The less frequent practice of sitting. on porches, expos- 
ed to the dew, in summer evenings. 

The universal use of stoves in places of public wor- 
ship. 

The abolition of the custom of obliging lying-in wo- 
men to sit up for company. 

The partial use of Schuylkill or hydrant water, for 
culinary and other purposes. 

The enjoyment of pure air, in country seats, in the 
neighbourhood of the city. They not only preserve 
from sickness during the summer and autumn, but they 
render families less liable to diseases during the other 
seasons of the year. 

And, lastly, the frequent use of private, and public 
warm and cold baths. For the establishment of the lat- 
ter, the citizens of Philadelphia are indebted to Mr. Jo- 
seph Simons. 



BETWEEN 1760 AND 1766, AND 1809. 237 

The following circumstances have an unfavourable in- 
fluence upon the health of our citizens. 

Ice creams taken in excess, or upon an empty stomach. 

The continuance of the practice of attending funerals, 
under all the circumstances that were mentioned in de- 
scribing the customs which prevailed in Philadelphia, 
between the years 1760 and 1766. 

The combined influence of great heat and intempe- 
rance in drinking, acting upon passions unusually excited 
by public objects, on the 4th of July every year. 

The general and inordinate use of segars. 

The want of sufficient force in the water which falls 
into the common sewers to convey their contents into 
the Delaware, renders each of their apertures a source 
of sickly exhalations to the neighbouring streets and 
squares. 

The compact manner in which the gutters are now 
formed, by preventing the descent of water into the 
earth, has contributed very much to retain the filth of the 
city, in those seasons in which they are not washed by 
rain, nor by the waste water of the pumps and h}drants. 

The timbers of many of the wharves of the city have 
gone to decay. The docks have not been cleaned since 
the year 1774, and many of them expose large surfaces 
to the action of the sun at low water. The buildings 
have increased in Water-street, and with them there has 
been a great increase of that kind of filth which is gen- 
erated in all houses ; the stores in this street often contain 
matters which putrefy ; from all which there is, in warm 
weather, a constant emission of such a foetid odour, as to 
render a walk through that street, by a person who does 
not reside there, extremely disagreeable, and sorSetimes 
to produce sickness and vomiting. 

In many parts of the vicinity of the city arc to be seen 
pools of stagnating Water, from which there are exhaled 
large- quantities of unhealthy vapours, during the summer 
and autumnal months. 

The privies have become so numerous, and are often 
so full, as to become offensive in most of the compact 
parts of the city, more especially in damp weather. 

The pump water is impregnated with many saline and 
aerial matters of an offensive nature. 



238 STATE OF MLDICINZ, 

While these causes exert an unfriendly influence upon 
the bodies of the' citizens of Philadelphia, the extreme 
elevation or depression of their passions, by the different 
issues of their political contests, now far surpassing, in 
their magnitude, the contests of former years, together with 
their many new and fortuitous modes of suddenly acquir- 
ing and losing property, predispose them to many diseases 
of the mind. 

The present diseases of Philadelphia come next under 
our consideration. 

Fevers have assumed several new forms since the year 
1766. The mild bilious fever has gradually spread over 
every part of the city. It followed the filth which was left 
by the British army in the year 1778. In the year 1780, 
it prevailed, as an epidemic, in Southwark, and in Water 
and Front- streets, below Market- street.* ■ In the years 
1791 and 1792, it assumed an inflammatory appearance, 
and was accompanied, in many cases, with hepatic affec- 
tions. The connection of our subject requires that I should 
barely repeat, that it appeared in 1793 as an epidemic, in 
the form of what is called yellow fever, in which form it 
has appeared, in sporadic cases, or as an epidemic, nearly 
every year since. During the reign of this high grade of 
bilious fever, mild intermittents and remittents, and the 
chronic or nervous forms of the summer and autumnal 
fever, have nearly disappeared. 

Inflammations and obstructions of the liver have been 
more frequent than in former years, and even the pneumo- 
nies, catarrhs, intercurrent, and other fevers of the winter 
and spring months, have all partaken more or less of the 
inflammatory and malignant nature of the yellow fever. 

The pulmonary consumption continues to be a common 
disease among both sexes. Women are more subject to 
it than men, in consequence of their light dresses, and par- 
ticularly of the exposure of their upper arms (a part of the 
body with which the lungs sympathise in a peculiar man- 

* It appears, from the account given by Mr. White of the bilious fever 
of Bath, that it prevailed several years in its suburbs, before it became 
general in that city. It is remarkable, that Southwark was nearly the 
exclusive seat, not only of the bilious or breakbone fever of 1780, but of 
the intermitting fever in 1765, taken notice of by Dr. Bond, and of the 
yellow fever of 1805. 



BETWEEN 1760 AND 1766, AND 1809. 239 

ner) to the cold air. The frequency of consumptions 
from this cause, has given rise to a saying that " the 
nakedness of the women, is the cloathing of the physi- 
cians." 

The cynanche trachealis, the scarlatina anginosa, the 
hydrocephalus internus, and cholera infantum, are like- 
wise common diseases in Philadelphia. 

Madness, and several other diseases of the mind, have 
increased since the year 1766, from causes which have 
been mentioned. 

Several of the different forms of gout are still common 
among both sexes. 

Apoplexy and palsy have considerably diminished in 
our city. It is true, the bills of mortality still record a 
number of deaths from the former, every year ; but this 
Statement is incorrect, if it mean a disease of the brain 
only, for sudden deaths from all their causes are returned 
exclusively under the name of apoplexy. The less fre- 
quent occurrence of this disease, also of palsy, is proba- 
bly occasioned by the less consumption of animal food, 
and of distilled and fermented liquors, by that class of 
citizens who are most subject to them, than in former 
years. Perhaps the round hat, and the general use of 
umbrellas, may have contributed to lessen those diseases 
of the brain. 

The dropsy is now a rare disease, and seldom seen even 

in our hospital. 

The colica pictonum, or dry gripes, is scarcely known 
in Philadelphia. I have ascribed this to the use of flan- 
nel next to the skin as a part of dress, and to the general 
disuse of punch as a common drink. 

The natural small-pox is nearly extirpated, and the 
puerperile fever is rarely met with in Philadelphia. The 
scrophula is much less frequent than in former years. It 
is confined chiefly to persons in humble life. 

I proceed, in the order that was proposed, to take notice 
of the present medical opinions which prevail among the 
physicians of Philadelphia. The system of Dr. Boerhaave 
Ion"- ago ceased to regulate the practice of physic. It 
was succeeded by the system of Dr. Cullen. In the year 
1 790, Dr. Brown's system of medicine was introduced 



240 STATE OF MEDICINE, 

and taught by Dr. Gibbon. It captivated a few young 
men for a while, but it soon fell into disrepute. Perhaps 
the high-toned diseases of our city exposed the fallacy 
and danger of the remedies inculcated by it, and afforded 
it a shorter life than it has had in many other countries. 
In the year 1790, the author of this inquiry promulgated 
some new principles in medicine suggested by the peculiar 
phenomena of the diseases of the United States. These 
principles have been so much enlarged and improved by 
the successive observations and reasonings of many gen- 
tlemen in all the states, as to form a new system of me- 
dicine. This system rejects the nosological arrangement 
of diseases, and admits only of a single disease, consisting 
in different forms of morbid excitement, induced by irri- 
tants acting upon previous debility. It rejects further, 
an undue reliance upon the powers of nature, and teaches, 
instantly to wrest the cure of all violent and feeble diseases 
out of her hands ; and lastly it rejects prescriptions for 
the names of diseases ; and by directing their application 
wholly to their forming and fluctuating states, derives 
from a few active medicines all the advantages which have 
been in vain expected from the numerous articles which 
compose European treatises upon the materia medica. 
This system has been adopted by a part of the physicians 
of Philadelphia, but a respectable number of them are 
still attached to the system of Dr. Cullen. 

A great change has taken place in the remedies which 
are now in common use in Philadelphia. I shall briefly 
mention such of them as are new, and then take notice 
of the new and different modes of exhibiting such as were 
in use between the years 1760 and 1766. 

Vaccination has been generally adopted in our city, in 
preference to inoculation with variolous matter. 

Digitalis, lead, zinc, and arsenic are now common re- 
medies in the hands of most of our practitioners. 

Cold air, cold water, and ice are among the new reme- 
dies of modern practice in Philadelphia. 

Blood-letting is now used in nearly all diseases of vio- 
lent excitement, not only in the blood-vessels, but in 
other parts of the body. Its use is not, as in former times, 
limited to ounces in specific diseases, but regulated by 



BETWEEN 1760 AND 1766, AND 1809. 241 

their force, and the importance of the parts affected to 
health and life ; nor is it forbidden, as formerly, in infancy 
nor in extreme old age, nor in the summer months, nor 
in those cases in which the blood is dissolved, or devoid 
of an inflammatory crust, provided the pulse be full or 
tense, nor in the period of menstruation, where symptoms 
of a violent, or of a suffocated disease, manifested by an 
active or a feeble pulse, indicate it to be necessary. 

Leeches are now in general use in diseases which are 
removed, by their seat or local nature, beyond the influ- 
ence of the lnncet. For the introduction of this excel- 
lent remedy into our city we are indebted to Mr. John 
Cunitz. 

Opium and bark, which were formerly given in dis- 
guise, or with a trembling hand, are now, not only pre- 
scribed by physicians, but often purchased, and taken 
without their advice, by many of the citizens of Philadel- 
phia. They even occupy a shelf in the closets of many 
families. 

The use of mercury has been revived, and a salivation 
has been extended, with great improvements and success, 
to nearly all violent and obstinate diseases. Nor has the 
influence of reason over ignorance and prejudice, with re- 
spect to that noble medicine, stopped here. Cold water, 
once supposed to be incompatible with its use, is now 
applied to the body, in malignant fevers, in order to in- 
sure and accelerate its operation upon the salivary glands. 
But this is not all. It is applied locally, and universally 
to restrain, or to check a salivation, when it exceeds in its 
degree or duration, the exigencies of a disease, or the 
wishes of a physician. 

Wine is given in large quantities, when indicated, 
without the least fear of producing intoxication. 

The warm and cold baths, which were formerly con- 
fined chiefly to patients in the Pennsylvania hospital, are 
now common prescriptions in private practice. 

Exercise, country air, mineral springs, and the sea 
shore, are now universally recommended in chronic dis- 
eases, and in the debility which precedes and follows 
them. 

vol. tv. h h 



242 STATE OF MEDICINE, 

Great pains are now taken to regulate the quantity and 
quality of aliments and drinks, by the peculiar state of the 
system. 

Let us now inquire into the influence of the new opin- 
ions in medicine, and the new remedies which have been 
mentioned, upon human life. 

The small-pox, once the most fatal and universal of all 
diseases, has nearly ceased to occupy a place in our bills 
of mortality, by the introduction of vaccination in our 
city. For the prompt adoption of this great discovery, 
the citizens of Philadelphia owe a large debt of gratitude 
to Dr. Coxe, and Mr. John Vaughan. 

Fevers, from all their causes, and in all their forms, with 
the exception of the bilious yellow fever, now yield to me- 
dicine. Even that most malignant form of febrile diseases 
is treated with more success in Philadelphia than in other 
countries. It would probably seldom prove mortal, did 
a belief in its being derived from an impure atmosphere, 
and of its exclusive influence upon the body, while it 
prevailed as an epidemic, obtain universally among the 
physicians and citizens of Philadelphia. 

The pulmonary consumption has been prevented, in 
many hundred instances, by meeting its premonitory signs, 
in weakness and feeble morbid excitement in the whole 
system, by country air, gentle exercise, and gently stim- 
ulating remedies. Even when formed, and tending rapid- 
ly to its last stage, it has been cured by small and frequent 
bleedings, digitalis, and a mercurial salivation. 

The hydrocephalus internus, the cynanche trachcalis, 
and cholera infantum, once so fatal to the children of our 
city, now yield to medicine in the early stages. The two 
former are cured by copious bleeding, aided by remedies 
formerly employed in them without success. The last 
is cured by moderate bleeding, calomel, laudanum, and 
country air. 

The gout has been torn from its aucient sanctuary in 
error and prejudice, and its acute paroxysms now yield 
with as much certainty to the lancet, as the most simple 
inflammatory diseases. 

The dropsy is cured by renouncing the unfortunate 
association of specific remedies with its name, and accom- 



BETWEEN 1760 AND 1766, AND 1809. 243 

modating them to the degrees of excitement in the blood- 
vessels. 

The tetanus from wounds is now prevented, in most 
cases, by inflaming the injured parts, and thereby com- 
pelling them to defend the whole system, by a local dis- 
ease. Where this preventing remedy has been neglected, 
and where tetanus arises from other causes than wounds, 
it has often been cured by adding to the diffusible stimu- 
lus of opium, the durable stimuli of bark and wine. 

Death from drinking cold water, in the heated state of 
the body, is now obviated by previously wetting the hands 
or feet with the water ; and when this precaution is ne- 
glected, the disease induced by it, is generally cured by 
large doses of liquid laudanum. 

Madness, which formerly doomed its miserable subjects 
to cells or chains for life, has yielded to bleeding, low diet, 
mercury, the warm and cold baths, fresh air, gentle exer- 
cise, and mild treatment, since its seat has been discovered 
to be in the blood- vessels of the brain. 

The last achievement of our science in Philadelphia, 
that I shall mention, consists in the discovery and observa- 
tion of the premonitory signs of violent and mortal diseases, 
and in subduing them by simple remedies, in their form- 
ing state. By this means, death has been despoiled of his 
prey, in many hundred instances. 

In this successful conflict of medicine with disease and 
death, midwifery and surgery have borne a distinguished 
part. They derive their claims to the gratitude of the 
citizens of Philadelphia from the practice of each of them 
being more confined, than formerly, to a few members of 
our profession. It is in consequence of the former being 
exercised only by physicians of regular and extensive edu- 
cations, that death from pregnancy and parturition is a rare 
occurrence in Philadelphia. For the discovery and intro- 
duction of the means of preventing it from the latter dis- 
ease by copious blood-letting, also for the discovery of the 
partial inversion of the uterus, and the method of reducing 
it, the citizens of Philadelphia are indebted to Dr. -De- 
wees. 

I should greatly exceed the limits prescribed to this in- 
quiry, should I mention how much pain and misery have 
been relieved, and how often death has been baffled in his 



244 STATE OF MEDICINE, 

attempts upon human life, by several late improvements 
in old, and the discovery of new remedies in surgery. I 
shall briefly name a few of them. 

In cases of blindness, from a partial opacity of the cor- 
nea, or from a closure of the natural pupil, a new pupil 
has been made ; and where the cornea has been partially 
opaque, the opening through the iris has been formed, 
opposite to any part of it, which retain its transparency. 

The cure of fractures has been accelerated by blood- 
letting, and, where the union of a broken bone has not 
taken place from a defect of bony matter, it has been pro. 
duced by passing a seton between the fractured ends of 
the bone, and effecting a union thereby between them. 
Luxations, which have long resisted both force and art, 
have been reduced in a few minutes, and without pain, 
by bleeding at deliquium animi. 

Old sores have been speedily healed, by destroying 
their surfaces, and thereby placing them in the condition 
of recent accidents. 

Erysipelas is cured, and external mortifications are 
checked, by the application of blisters to the parts af- 
fected. 

The fruitless application of the trepan, in concussions 
in the brain, has been prevented by copious bleeding and 
a salivation. 

A suppression of urine has been cured, by the addition 
of a piece of a bougie, to a flexible catheter. 

Strictures in the urethra have been removed by means 
of a caustic, also, in a more expeditious way, by dividing 
them with a lancet. 

Hydrocele has been cured by a small puncture, and 
afterwards exciting inflammation and adhesion by an in- 
jection of wine into the tunica vaginalis testis. 

The popliteal aneurism and varicose veins have both 
been removed by operations that were unknown a few 
years ago. 

For the introduction of several of those new surgical 
remedies, and for the discovery and improvement of others, 
the citizens of Philadelphia are indebted to Dr. Physick. 
They are likewise indebted to him and Dr. Grifntts for 
many of the new and successful modes of practice, in the 



BETWEEN 1760 AND 1766, AND 1809. 245 

diseases that have been mentioned. Even the few remedies 
that have been suggested by the author of these inquiries, 
owe their adoption and usefulness chiefly to the influence 
of those two respectable and popular physicians. 

Before I dismiss this part of our subject, I have only 
to add, that since the cure and extraction of the teeth have 
become a distinct branch of the profession of medicine, 
several diseases which have arisen from them, when de- 
cayed have been detected and cured.* 

W e have thus taken a comparative view of the medical 
theories and remedies of former and modern times, and 
of their different influence upon human life. To exhibit 
the advantages of the latter over the former, I shall men- 
tion the difference in the number of deaths in three suc- 
cessive years, at a time when the population of the city 
and suburbs was supposed to amount to 30,000 souls, 
and in three years, after the population exceeded double 
that number. 

Between the 25th of December, 1771, and the 25th 
of December, 1772, there died 1291 persons. 

Between the same days of the same months, in 1772 
and 1773, there died 1344 persons. 

Within the same period of time, between 1773 and 
1774, the deaths amounted to 1021, making in all 3,656. 
I regret that I have not been able to procure the returns 
of deaths in years prior to those which have been men- 
tioned. During the three years that have been selected, 
no unusually mortal diseases prevailed in the city. The 
measles were epidemic in 1771, but were not more fatal 
than in common years. 

Between the 25th of December, 1799, and the 25th of 
December, 1800, there died 1525 persons. 

Between the same days of the same months, in the 
years 1801 and 1802, there died 1362 persons. 

Within the same period of time, between 1802 and 
1803, the deaths amounted to 1796, making in all 4,883. 

Upon these returns it will be proper to remark, that 
several hundreds of the deaths, in 1802 and 1803, were 

* The late Mr. Andrew Spence was the first repulur bred dentist thai 
settled in Philadelphia. There are now several well educated gentlemen 
in the city of that profession. 



246 STATE OF MEDICINE, 

from the yellow fever, and that many of them were of 
strangers. Of 68 persons, who were interred in the Swedes' 
church-yard alone, one half were of that description of 
people. Deducting 500 from both those causes of extra- 
mortality in the three years, between 1799 and 1803, the 
increase of deaths above what they were in the years 1771 
and 1774 is but 727. Had diseases continued to be as 
mortal as they were thirty years ago, considering the pre- 
sent state of our population, the number of deaths would 
have been more than 7,312. 

To render the circumstances of the statement of deaths 
that has been given perfectly equal, it will be necessary to 
add, that the measles prevailed in the city, in the year 1802, 
as generally as they did in 1771. 

From the history that has been given, of the effects of 
the late improvements and discoveries in medicine upon 
human life, in Philadelphia, we are led to appreciate its 
importance and usefulness. It has been said, by its ene- 
mies, to move ; but its motions have been asserted to be 
only in a circle. The facts that have been stated clearly 
prove, that it has moved, and rapidly too, within the last 
thirty years, in a straight line. 

To encourage and regulate application and enterprize in 
medicine hereafter, let us inquire to what causes we are 
indebted for the late discoveries and improvements in our 
science, and for their happy effects in reducing the num- 
ber of deaths so far below their former proportion to the 
inhabitants of Philadelphia. 

The first cause I shall mention is the great physical 
changes which have taken place in the manners of our 
citizens in favour of health and life. 

A second cause, is the assistance which has been afford- 
ed to the practice of physic, by the numerous and impor- 
tant discoveries that have lately been made in anatomy, 
natural history, and chemistry, all of which have been con- 
a eyed, from time to time, to the physicians of the city, by 
means of the Philadelphia and hospital libraries, and by the 
lectures upon those branches of science which are annually 
delivered in the university of Pennsylvania. 

3. The rejection of the supposed healing powers of na- 
ture in all diseases of great, and feeble morbid action, 
and the preference which is given to the more prompt, and 



BETWEEN 1760 AND 1766, AND 1809. 247 

safe method of curing them by means of artificial reme- 
dies, have added very much to the utility and credit of 
medicine in our city. 

4. The application of reasoning to our science has con- 
tributed greatly to extend its success in the cure of dis- 
eases. Simply to observe and to remember, are the hum- 
blest operations of the human mind. Brutes do both. But 
to theorize, that is, to thinfc, or in other language, to com- 
pare facts, to reject counterfeits, to dissolve the seeming 
affinity of such as are not true, to combine those that are 
related, though found in remote situations from each other, 
and, finally, to deduce practical and useful inferences from 
them, are the high prerogatives and interest of man, in all 
his intellectual pursuits, and in none more, than in the pro- 
fession of medicine. 

5. The accommodation of remedies to the changes which 
are induced in diseases by the late revolutions in our cli- 
mate, seasons, and manners, has had a sensible influence 
in improving the practice of medicine in our city. The 
same diseases, like the descendants of the same families, 
lose their resemblance to each other by the lapse of time ; 
and the almanacks of 1803 might as well be consulted to 
inform us of the monthly phases of the moon of the pre- 
sent year, as the experience of former years, or the books 
of foreign countries, be relied upon to regulate the practice 
of physic at the present time, in any of the cities of the 
United States. 

6. From the diffusion of medical knowledge among all 
classes of our citizens, by means of medical publications, 
and controversies, many people have been taught so much 
of the principles and practice of physic, as to be able to 
prescribe for themselves in the forming state of acute dis- 
eases, and thereby to prevent their fatal termination. It 
is to this self-acquired knowledge among the citizens of 
Philadelphia, that physicians are in part indebted for not 
being called out of their beds so frequently as in former 
vears. There are few people who do not venture to ad- 
minister laudanum in bowel complaints, and there are some 
persons in the city, who have cured the cynanche trachealis 
when it has occurred in the night, by vomits and bleeding, 
without the advice of a physician. The disuse of suppers 



248 STATE OF MEDICINE, 

is another cause why physicians enjoy more rest at night 
than formerly, for many of their midnight calls, were to 
relieve diseases brought on by that superfluous meal. 

7. The dispensary instituted in our city, in the year 
1786, for the medical relief of the poor, has assisted very 
much in promoting the empire of medicine over disease 
and death. Some lives have likewise been saved by the 
exertions of the humane society, by means of their printed 
directions to prevent sudden death ; also, by the medical 
services which have lately been extended to out-patients, 
by order of the managers of the Pennsylvania hospital. 

8thly and lastly. A change, favourable to successful 
practice in Philadelphia, has taken place in the conduct of 
physicians to their patients. A sick room has ceased to 
be the theatre of imposture in dress and manners, and pre 
scriptions are no longer delivered with the pomp and au- 
thority of edicts. On the contrary, sick people are now 
instructed in the nature of their diseases, and informed of 
the names and design of their medicines, by which means 
faith and reason are made to co-operate in adding efficacy 
to them. Nor patients left, as formerly, by their physi- 
cians, under the usual appearances of dissolution, without 
the aid of medicine. By thus disputing every inch of 
ground with death, many persons have been rescued from 
the grave, and lived years afterwards, monuments of the 
power of the healing art. 

From a review of what has been effected within the last 
nine and thirty years, in lessening the mortality of many 
diseases, Ave are led to look forward with confidence and 
pleasure to the future achievements of our science. 

Could we lift the curtain of time which separates the 
year 1847 from our view, we should see cancers, pul- 
monary consumptions, apoplexies, palsies, epilepsy and 
hydrophobia struck out of the list of mortal diseases 
and many others which still retain an occasional pow- 
er over life, rendered perfectly harmless, provided the 
same number of discoveries and improvements shall be 
made in medicine in the intermediate years, that have been 
made since the year 1766. 

But in vain will the avenues of death from those dis- 
eases be closed, while the more deadly yellow fever is per- 
mitted to supply their place, and to spread terror, dis- 



BETWEEN 1760 AND 1766, AND 1809. 249 

tress, and poverty through the city, by destroying the lives 
of her citizens by hundreds or thousands every year. Dear 
cradle of liberty of conscience in the western world ! nurse 
of industry and arts ! and patron of pious and benevolent 
institutions ! may this cease to be thy melancholy < 
ny ! May Heaven dispel the errors and prejudices of thy 
citizens upon the cause and means of preventing their 
pestilential calamities ! and may thy prosperity and hap- 
piness be revived, extended, and perpetuated for ages yet 
to come ! 



t i 



INDEX. 



AIR, the primary stimulus of life. ... 

Adam, the first motions of life in him from the stimulus of air 
Actions originally involuntary, become voluntary from habit 
Actions which become voluntary from habit again become in- 
voluntary ------ 

Arsenic, an account of its use in cancers 
Age, an account of the state of the body and mind in old 
Circumstances which favour longevity _ - - 

Phosnomena which occurs in the body and mind in old age 
Diseases of old age - 

Of the remedies for them - _ _ - 

Autumn, account of it in Pennsylvania - 
Air, cold and dry, when proper in pulmonary consumption 
Air, cool and cold advised in the gout - 

Arteries, facts in support of their muscularity and irrita- 
bility _.---- 

Arteriotomy, when necessary - - - 4 

Its advantages ------ 

B. 

Barometer, its mean elevation in Pennsylvania 
Bleeding, when proper in pulmonary consumption 

, advised in inflammatory gout - 

, in hydrophobia - 

, used in the yellow fever of 1793 

Blood not putrid in fevers - 

, appearances of it after bleeding in 1793 
Bleeding, its salutary effects in the fever of 1793 
Circumstances which regulated its use - 
Objections to it answered - - - - - 

Blisters useful in the fever <i 1793 
B irk hurtful in it, and in the yellow fever of 1794 
Bowels, complaints of in 1808, and their cause - 
Bluod-letting, a defence of it - 

What circumstances indicate it - 
Its salutary effects - 

Objections to it answered - - - - - 
Its advantages over all other depleting remedies 
Circumstances which regulate its use - 
Appearances of the blood to be attended to in advising it 
It is animated by the stimulus of disease 
The quantity of it which may be drawn with safety 
It is rapidh produced - 
Weeding useful in pregnancy - 
useful in parturition 



Vol, 


, Pagtf. 


i. 


8 


i. 


ibid 


i. 


10 


i- 


ibid. 


i. 


217 


i. 


235 


i. 


ibid. 


i. 


239 


i. 


246 


i. 


247 


ii. 


18 


ii. 


74 


ii. 


168 


iii 


7 


iv. 


124 


iv. 


ibid. 


ii. 


23 


ii. 


69 


ii. 


163 


ii. 


201 


iii. 


141 


iii. 


70 


iii. 


142 


iii. 


143 


iii. 


145 


iii. 


149 


iii. 


i 57 


iii. 


161 


iv. 


102 


iv. 


173 


iv. 




iv. 


174 


iv. 


178 


iv. 




iv. 


196 


iv. 


202 


iv. 


203 


iv. 


148 


iv. 


151 


iv. 


2! 8 


IV. 


219 



INDEX. 



Bleeding during the cessation of the menses 

in the disease from taking an excessive dose of 

opium ------ 

in the diabetes ----- 

in chronic imermittents - - - - 

in dislocated bones - 

Baths, warm and cold, when established in Philadelphia 

c. 



Vo!. 


Pa£f. 


IV. 


221 


iv. 


222 


iv. 


ibid. 


IV. 


223 


IV. 


ibid. 


IV. 


236 



Climate of Pennsylvania, history of 

its changes - 

Cold, its greatest degrees in Pennsylvania 

Consumption, pulmonary, thoughts upcn - - - 

Inquiry into its causes and cure -....--" 

Its predisposing cause - 

It is a disease of the whole system - 

It is more common among women than men 

It is not contagious - - 

Its supposed causes, proved to be its effects 

Its premonitory signs __._-- 

Its cure - - - 

Trachea diseased in it 

Anamalous symptoms described in it 

Divided into inflammatory, hectic, and typhus states 

Remedies for its inflammatory state _ - - 

Blood-letting ._-_-- 

Ve